Objectives: Sexually Transmitted Infections (STIs) have a great public health impact globally. STIs are one of the most critical health problems in the United States of America (USA). Here, we present a mathematical m...Objectives: Sexually Transmitted Infections (STIs) have a great public health impact globally. STIs are one of the most critical health problems in the United States of America (USA). Here, we present a mathematical model for testing several interventions that are designed for various communities in order to control the Chlamydia epidemic. Study Design: Based on a community sexual behavior survey, we constructed and parameterized a mathematical disease transmission model to estimate the spread dynamics of Chlamydia in young adults in the northern part of Omaha, Nebraska. Methods: A differential equations based continuous time simulation model is run for various scenarios. The model considers only one age group i.e., 19 - 25 ages, which is considered as the highest risk group for this sexually transmitted disease. Our model assumes homogeneous mixing within this age group and use published estimates to model mixing rates between individuals. Results: The presented model quantified the potential value of screening and treatment programs for Chlamydia in reducing the burden of disease in this specific community. By increasing the screening and treatment rates from 35% to 85%, great public health benefit can be achieved in two years, i.e., total cases reduction around 9% just in this considered age group. Conclusions: Computational results show that behavioral change based interventions on prevention have some effect on reducing the prevalence in the targeted age group;however, more benefit can be obtained with frequent screening and treatment programs.展开更多
A needs assessment of the knowledge, attitudes, practices, and beliefs about HIV/AIDS prevention was conducted among 100 Sudanese and Bantu Somali women immigrants aged 19 years and older, recruited through a communit...A needs assessment of the knowledge, attitudes, practices, and beliefs about HIV/AIDS prevention was conducted among 100 Sudanese and Bantu Somali women immigrants aged 19 years and older, recruited through a community organization between April and July 2006. Information was collected by interview using interpreters to administer a 60-item test and a 116-item questionnaire that had been translated into Nuer and Arabic. Women in this study had low levels of education, poor knowledge about HIV transmission and prevention and safer sex practices, and poor attitudes to HIV/AIDS. They believe that HIV/AIDS is a punishment from God, HIV-positive people should be separated from society, carrying a condom indicates having loose morals, women should not experience sexual pleasure, and men should decide when and how to have sexual intercourse. Education, gender, and cultural beliefs are critical in the spread of HIV. Efforts to educate immigrant and displaced populations, particularly women, are essential.展开更多
Wearable ultrasound devices represent a transformative advancement in therapeutic applications,offering noninvasive,continuous,and targeted treatment for deep tissues.These systems leverage flexible materials(e.g.,pie...Wearable ultrasound devices represent a transformative advancement in therapeutic applications,offering noninvasive,continuous,and targeted treatment for deep tissues.These systems leverage flexible materials(e.g.,piezoelectric composites,biodegradable polymers)and conformable designs to enable stable integration with dynamic anatomical surfaces.Key innovations include ultrasound-enhanced drug delivery through cavitation-mediated transdermal penetration,accelerated tissue regeneration via mechanical and electrical stimulation,and precise neuromodulation using focused acoustic waves.Recent developments demonstrate wireless operation,real-time monitoring,and closed-loop therapy,facilitated by energy-efficient transducers and AI-driven adaptive control.Despite progress,challenges persist in material durability,clinical validation,and scalable manufacturing.Future directions highlight the integration of nanomaterials,3D-printed architectures,and multimodal sensing for personalized medicine.This technology holds significant potential to redefine chronic disease management,postoperative recovery,and neurorehabilitation,bridging the gap between clinical and home-based care.展开更多
Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is importan...Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.展开更多
As drivers age, roadway conditions may become more challenging, particularly when normal aging is coupled with cognitive decline. Driving during lower visibility conditions, such as inclement weather, is especially ch...As drivers age, roadway conditions may become more challenging, particularly when normal aging is coupled with cognitive decline. Driving during lower visibility conditions, such as inclement weather, is especially challenging for older drivers due to their sensitivity to glare and reduced visibility. As a result, older drivers may adjust their behavior during adverse weather. This paper explores the differential impacts of weather on older drivers with cognitive decline compared to older drivers with normal cognitive function. Data were from a naturalistic driving study of older drivers in Omaha, Nebraska. Driver speed and weather data were extracted and the correlation between speed compliance, road weather conditions, and the cognitive/neurological status of the drivers was examined. Speed compliance was used as the surrogate safety measure since driving at lower speeds can indicate that the driver is challenged by roadway or environmental conditions and can therefore indicate a risk. The percentage of time during a trip when drivers were 16.1 kph under the speed limit was modeled as the dependent variable using beta regression. The variables that resulted in the best fit model were mild cognitive impairment (MCI), age group, traffic density, and weather. Results indicated that the youngest group of older drivers (young-old) spent less time driving at impeding speeds and had the least variability compared to the other two age groups. The middle group of older drivers (middle-old) had the highest amount of time driving at impeding speeds and had more variability than young-old drivers. The oldest group of older drivers (old-old) were the most likely to drive at impeding speeds and had the most variability. In general, older drivers were more likely to drive at impeding speeds during peak hours than during non-peak hours. Additionally, in most cases, older drivers spent less time below the speed limit when the weather was clear than in adverse conditions. Results indicate that older drivers are impacted by weather conditions, and distinct patterns were noted between older drivers who were cognitively impaired compared to drivers with normal cognition.展开更多
The unfolded protein response pathway is an evolutionarily conserved cytoprotective signaling cascade,essential for cell function and survival.Unfolded protein response signaling is tightly integrated with bone cell d...The unfolded protein response pathway is an evolutionarily conserved cytoprotective signaling cascade,essential for cell function and survival.Unfolded protein response signaling is tightly integrated with bone cell differentiation and function,and chronic unfolded protein response activation has been identified in bone disease.The unfolded protein response has been found to promote oncogenesis and drug resistance,raising the possibility that unfolded protein response modulators may have activity as anti-cancer agents.Cancer-associated bone disease remains a major cause of morbidity for patients with multiple myeloma or bone-metastatic disease.Understanding the critical role of unfolded protein response signaling in cancer development and metastasis,as well as its role in bone homeostasis,may lead to novel mechanisms by which to target cancer-associated bone disease.In this review,we summarize the current research delineating the roles of the unfolded protein response in bone biology and pathophysiology,and furthermore,review unfolded protein response modulating agents in the contexts of cancer and cancer-associated bone disease.展开更多
Low-density lipoprotein cholesterol(LDL-C)is the most causal risk factor for atherosclerotic cardiovascular disease(ASCVD).Red yeast rice(RYR)is a nutraceutical widely used as a lipid-lowering dietary supplement.The m...Low-density lipoprotein cholesterol(LDL-C)is the most causal risk factor for atherosclerotic cardiovascular disease(ASCVD).Red yeast rice(RYR)is a nutraceutical widely used as a lipid-lowering dietary supplement.The main cholesterol-lower agents in RYR are monacolins,particularly monacolin K,a weak reversible inhibitor of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase,whose daily consumption(up to 10 mg/day)reduces LDL-C plasma levels up to 34%within 6-8 weeks when compared to placebo.The reduction in LDL-C is often accompanied by lower levels of plasma apolipoprotein B,total cholesterol,matrix metalloproteinases 2 and 9,high-sensitivity C-reactive protein,non-high-density lipoprotein cholesterol,and blood pressure.RYR has also demonstrated favorable reductions of up to 45%compared to placebo in the risk of ASCVD events in secondary prevention studies.The mechanism of action is similar to statins.When consumed appropriately,RYR is associated with only minimal side effects.Mild myalgia may be seen in patients who cannot tolerate low-dose statins.In individuals with no additional ASCVD risk factors,RYR is a safe and effective supplement in treating mild to moderate hyperlipidemia.展开更多
BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits f...BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.展开更多
Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the lef...Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the left ventricular endocardial borders.Their use during echocardiography has become a valuable tool in non-invasive diagnostics.UCAs provide higher-quality images that may ultimately reduce the length of hospital stays and improve patient care.The higher cost associated with UCAs in many situations has been an impediment to frequent use.However,when used as an initial diagnostic test,UCA during rest echocardiogram is more cost-effective than the traditional diagnostic approach,which frequently includes multiple tests and imaging studies to make an accurate diagnosis.They can be easily performed across multiple patient settings and provide optimal images that allow clinicians to make sound medical decisions.This consequently allows for better diagnostic accuracies and improvement in patient care.展开更多
Sinus of Valsalva aneurysm(SoVA)is a rare cardiac defect that may be congenital or acquired.It is characterized by abnormal dilatation of the aortic root due to a weakened elastic lamina at the junction of the annulus...Sinus of Valsalva aneurysm(SoVA)is a rare cardiac defect that may be congenital or acquired.It is characterized by abnormal dilatation of the aortic root due to a weakened elastic lamina at the junction of the annulus fibrosus and the aortic media.SoVAs are present in approximately 0.09%of the general population and comprise up to 3.5%of all congenital cardiac defects.It is usually found inci-dentally on cardiac imaging,with a higher incidence observed in the Western populations and a male-to-female ratio of 4:1.A transthoracic two-dimensional echocardiogram is the initial diagnostic test of choice,which may reveal the characteristic“windsock deformity”that clinches the diagnosis.Other imaging modalities,such as transesophageal echocardiography and cardiac computed tomography angiography,help provide more extensive details of the aneurysm and its adjacent structures.Management options for ruptured and unruptured SoVA include surgical repair or transcatheter closure,which serves as a game-changing development in treatment.This article aims to provide background information on the epidemiology,pathophysiology,diagnosis,and recent advan-cements over the past decade in the management of SoVAs.展开更多
In general,the use of steroids is associated with three forms of liver injury that include hepatitis B reactivation,drug-induced liver injury,and steatosis/steatohepatitis.Drug-induced liver injury is a known but rare...In general,the use of steroids is associated with three forms of liver injury that include hepatitis B reactivation,drug-induced liver injury,and steatosis/steatohepatitis.Drug-induced liver injury is a known but rare adverse effect of highdose steroids.While corticosteroids,including methylprednisolone,are generally considered safe,high doses have been linked to hepatic injury.This form of insult is often idiosyncratic and unpredictable.We present the case of a 60-year-old female who was admitted due to a 6-week history of paresthesia and weakness involving her bilateral hands and feet.Magnetic resonance imaging of the brain,cervical,and thoracic regions revealed several enhancing lesions,highly concerning for multiple sclerosis.One day following high-dose intravenous methylprednisolone,liver enzymes were found to be significantly elevated on her complete metabolic panel.Steroid therapy was discontinued,and liver enzymes returned to normal values within 4 days.Symptoms ultimately resolved following a 7-day course of plasmapheresis.This article brings attention to providers about this rare adverse effect,especially to clinical specialists who often use high-dose steroids.Suggestions regarding monitoring and treatment are also provided.展开更多
Texas is the largest state by area in the US after Alaska,and one of the top states in the production and consumption of electricity with many coal-fired plants.Coal-fired power plants emit greater than 70% of polluta...Texas is the largest state by area in the US after Alaska,and one of the top states in the production and consumption of electricity with many coal-fired plants.Coal-fired power plants emit greater than 70% of pollutants in the energy sector.When coal is burned to produce electricity,nitrogen oxides(NO_(x))are released into the air,one of the main pollutants that threaten human health and lead to a large number of premature deaths.The key to effective air quality management is the strict compliance of all plants with emission standards.However,not all Texas coal plants have the environmental equipment to lower pollutant emissions.Nitrogen dioxide(NO2)observations from the TROPOspheric Monitoring Instrument(TROPOMI)were used to evaluate the emissions for Texas power plants.Data from both the Emissions and Generation Resource Integrated Database(EGRID)and the Emissions Database for Global Atmospheric Research(EDGAR)were used to examine emissions.It was found that NOx emissions for Texas power plants range from 1.53 kt/year to 10.99 kt/year,with the Martin Lake,Limestone and Fayette Power Project stations being the top emitters.WA Parish and Martin Lake stations have the strongest NOx fluxes,with both exhibiting significant seasonal variability.Comparisons of bottom-up inventories for EDGAR and EGRID show a high correlation(r=0.956)and a low root mean square error(0.766).A more reasonable control policy would lead to much reduced NOx emissions.展开更多
Background:Reliable animal models are crucial to drug development for focal segmental glomerulosclerosis(FSGS),a rare kidney disease.Variability in success rates in literature and significant ethical concerns with ani...Background:Reliable animal models are crucial to drug development for focal segmental glomerulosclerosis(FSGS),a rare kidney disease.Variability in success rates in literature and significant ethical concerns with animal welfare necessitate further optimization of adriamycin(ADR)-induced FSGS model developed on BALB/c mice.Methods:High-performance liquid chromatography(HPLC)was used to assess ADR stability in water and upon light exposure.To identify the optimal ADR level,single intravenous ADR injections with dosing levels from 10 to 17 mg/kg body weight were administered to BALB/c mice to induce FSGS-like pathology.Body weight and proteinuria of FSGS mice were monitored and analyzed for FSGS model-associated morbidity.Animals were euthanized for hematological and kidney histological assessments 8 weeks post induction.To identify the suitable experiment time frame of the ADR-induced FSGS mouse model,a longitudinal study was performed,with an 11-week continuous monitoring of the symptoms.Results:ADR was found to be unstable in aqueous media and light sensitive.A dosing level of 10.5 mg/kg of ADR was optimal for consistent FSGS mouse model induction on BALB/c strain,characterized by minimal mortality and sustained FSGS-like symptoms.Findings from the longitudinal study suggest that 6 weeks post ADR induction may represent the peak of FSGS pathology severity in this mouse model.This time frame may be used for FSGS drug development projects.Conclusion:Based on the outcome from this study,we identified the optimal ADR dosing level and model testing duration.A standard operating procedure(SOP)for the ADR-induced FSGS mouse model was established to facilitate FSGS basic research and drug development.展开更多
BACKGROUND Patients and providers are often unaware of available treatment options for alcohol use disorder(AUD)and how to pursue them.AIM To improve AUD treatment rates using an educational video module(EVM).METHODS ...BACKGROUND Patients and providers are often unaware of available treatment options for alcohol use disorder(AUD)and how to pursue them.AIM To improve AUD treatment rates using an educational video module(EVM).METHODS Prospective single-center cohort study evaluating the impact of a novel interactive patient EVM in promoting AUD treatment among hospitalized patients with alcohol-associated liver disease.Treatment was defined as receiving medication or participating in psychosocial treatment within 30 days of discharge.Primary outcome was change in treatment rates after viewing the EVM compared to a retrospective control cohort.Secondary outcomes were predictors of receiving treatment,EVM feedback,30-day hospital readmission,outpatient follow-up,return to alcohol use,and mortality.RESULTS Forty-two patients were included.Mean age was 45 years,50%were female,and mean model for end-stage liver disease score 15.5.After viewing the EVM,treatment rates increased for pharmacologic(50%vs 22%,P=0.0008)and psychosocial treatment(73.8%vs 44%,P=0.01).Return to alcohol use was significantly lower(7.9%vs 35.6%,P=0.003).All 100%of patients would recommend the EVM.CONCLUSION EVM allows hospitalized patients to receive standardized education about AUD treatment.This may address patient and provider knowledge gaps and reduce the growing burden of alcohol-associated liver disease.Future studies should evaluate EVM in larger patient populations using a multi-center study design.展开更多
BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver canc...BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver cancer and liver failure,with Hepatitis B and Hepatitis C being the most common viruses associated with these outcomes.AIM To study viral hepatitis-related mortality trends from 1999 to 2022,focusing on gender,race/ethnicity,age,region,and urban/rural classifications.METHODS We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify viral hepatitis-related deaths in the United States from 1999 to 2022.Data on demographic and regional information were analyzed and stratified by gender,race/ethnicity,age,regional,and urban rural classifications.Using the Joinpoint Regression Program(version 4.9.0.0 used,available from the National Cancer Institute,Bethesda,Maryland)the annual percentage change(APC)and average APC(AAPC)were calculated with 95%CI for extracted Age Adjusted Mortality Rates(AAMR).RESULTS From 1999 to 2022,there were 389916 viral hepatitis-related deaths in the United States.The overall AAMR increased from 1999 to 2013(APC:3.20%;95%CI:2.54-3.99;P<0.001),then declined through 2022(APC:-5.54%;95%CI:-6.75 to-4.47;P<0.001).Males accounted for 70.4%of deaths,with steeper declines in females(AAPC:-0.48%;95%CI:-0.87 to-0.12;P<0.05).The American Indian/Alaska Native population had the highest AAMR(AAPC:2.90%;95%CI:2.30 to 3.68;P<0.001).The population of 65-74 years had the largest increase in overall crude mortality rate(AAPC:3.20%;95%CI:2.77 to 3.85;P<0.001).Mortality was highest in the West(AAPC:-0.78%;95%CI-1.28 to-0.29;P<0.05).Rural AAMR exceeded urban rates after 2015.CONCLUSION This study found significant racial,ethnic,and geographical disparities in viral hepatitis AAMR.Key factors for mortality reduction include patient education,screening,and access to hepatitis vaccination and treatment.展开更多
In this article,we provide an important commentary on the original study Lu et al,which offers insight into the surgical efficacy of transanal total mesorectal excision(TaTME)vs laparoscopic total mesorectal excision(...In this article,we provide an important commentary on the original study Lu et al,which offers insight into the surgical efficacy of transanal total mesorectal excision(TaTME)vs laparoscopic total mesorectal excision(LapTME)in the management of low-lying locally advanced rectal cancer(LARC).We focus specifically on the rate of postoperative complications between the two using existing data from the literature.We additionally introduce robotic total mesorectal excision(RTME)and look at its postoperative complications relative to the TaTME and LapTME.LARC has been conventionally approached by open surgery.However,minimally invasive techniques have emerged over the past two decades as alternatives to open total mesorectal excision,namely robotic,laparoscopic,and transanal.Each approach has its supporters,but conflicting data on resection outcomes and complications has fueled ongoing debate over the optimal minimally invasive technique for low/mid-LARC.This article aims to extend on the data regarding the use of TaTME and RTME in the treatment of low/mid-LARC and further elaborate on their comparative efficacy relative to LapTME.展开更多
Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous ma...Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous manifestations that may hold diagnostic and prognostic significance. Patients with BMES have reported localized erythema, dermal thickening, and induration overlying the affected joints, which are hypothesized to reflect microvascular compromise and inflammatory processes within the bone and adjacent soft tissues. Dermatologic signs are likely linked to regional hyperemia, venous stasis, and cytokine-mediated inflammation, paralleling the pathophysiological mechanisms underlying intraosseous edema. Elevated intraosseous pressure in BMES may disrupt local perfusion, resulting in ischemia-reperfusion injury and subsequent vascular leakage, which manifests in visible cutaneous changes. Pro-inflammatory mediators, such as interleukin-1β and vascular endothelial growth factor (VEGF), central to BMES pathogenesis, may exacerbate endothelial activation, and dermal involvement. Histopathologic studies of affected skin have revealed perivascular lymphocytic infiltration and increased dermal vascularity, further supporting the theory of a shared ischemic and inflammatory pathway between bone and skin. Although MRI remains the gold standard for BMES diagnosis, recognition of these cutaneous manifestations could expedite orthopedic referral and intervention, especially in cases where imaging is delayed or symptoms are ambiguous. Current treatment options, including bisphosphonates, prostacyclin analogs, and offloading of weight bearing, may benefit from integration with dermatologic strategies to alleviate localized cutaneous symptoms and improve patient comfort. Evaluating the molecular and vascular links between BMES and its cutaneous manifestations provides an opportunity to refine diagnostic protocols and therapeutic approaches, offering a comprehensive understanding of the systemic interplay between dermal and skeletal pathophysiology, and optimizing clinical outcomes for patients affected by BMES.展开更多
Integrins are heterodimeric transmembrane receptors that mediate bidirectional interactions between the intracellular cytoskeletal array and the extracellularmatrix.These interactions are critical in tissue developmen...Integrins are heterodimeric transmembrane receptors that mediate bidirectional interactions between the intracellular cytoskeletal array and the extracellularmatrix.These interactions are critical in tissue development and function by regulating gene expression and sustaining tissue architecture.In humans,the integrin family is composed of 18 alpha(α)and 8 beta(β)subunits,constituting 24 distinctαβcombinations.Based on their structure and ligandbinding properties,only a subset of integrins,8 out of 24,recognizes the arginine-glycine-aspartate(RGD)tripeptide motif in the native ligand.One of the major RGD binding integrins is integrin alpha 8 beta 1(α8β1),a central Ras homolog gene familymemberA(RHOA)-dependentmodulator highly expressed in cells with contractile function.This review focuses on the recent advances regardingα8β1 function during organ development,with a particular interest in kidney and inner ear development.We alsodiscussα8β1’s role ininjury anddisease and its importance formesenchymal to epithelial transition during cancer development.Finally,we highlightα8β1’s importance for hearing function and its future use as a potential diagnostic and therapeutic tool for disease elimination.展开更多
Temperate forest ecosystems are important habitats for many bat species. However, these habitats are increasingly affected by anthropogenic disturbances, particularly urban development, leading to landscapes with vary...Temperate forest ecosystems are important habitats for many bat species. However, these habitats are increasingly affected by anthropogenic disturbances, particularly urban development, leading to landscapes with varying land cover composition and configuration. Limited research has examined how forest and urban landscape composition and configuration influence bat activity and diversity. Using a multi-year statewide bat acoustic monitoring dataset from North Carolina, USA, we investigated the effects of forest and urban composition and configuration at multiple spatial scales on bat activity and diversity. First, we constructed single-variable landscape index regression models and found that both the composition and configuration of forests and urban developments influenced bat activity and diversity in a species-specific manner. Next, we applied a hierarchical partitioning approach to compare the relative contributions of composition and configuration indices in explaining variance in bat activity. For big brown bats and hoary bats, evergreen forest and urban development composition indices contributed the most to explaining activity variance. In contrast, for eastern red bats, evening bats, and tricolored bats, deciduous forest fragmentation indices describing landscape configuration were the most influential factors. Silver-haired bat activity variance was primarily explained by an evergreen forest fragmentation index. Lastly, urban development configuration indices were the strongest predictors of Mexican free-tailed bat activity and total bat activity. These results suggest that forest and urban landscape configuration should be considered in conservation and management planning for North American temperate forest ecosystems, particularly in regions that have not experienced drastic deforestation in recent decades.展开更多
文摘Objectives: Sexually Transmitted Infections (STIs) have a great public health impact globally. STIs are one of the most critical health problems in the United States of America (USA). Here, we present a mathematical model for testing several interventions that are designed for various communities in order to control the Chlamydia epidemic. Study Design: Based on a community sexual behavior survey, we constructed and parameterized a mathematical disease transmission model to estimate the spread dynamics of Chlamydia in young adults in the northern part of Omaha, Nebraska. Methods: A differential equations based continuous time simulation model is run for various scenarios. The model considers only one age group i.e., 19 - 25 ages, which is considered as the highest risk group for this sexually transmitted disease. Our model assumes homogeneous mixing within this age group and use published estimates to model mixing rates between individuals. Results: The presented model quantified the potential value of screening and treatment programs for Chlamydia in reducing the burden of disease in this specific community. By increasing the screening and treatment rates from 35% to 85%, great public health benefit can be achieved in two years, i.e., total cases reduction around 9% just in this considered age group. Conclusions: Computational results show that behavioral change based interventions on prevention have some effect on reducing the prevalence in the targeted age group;however, more benefit can be obtained with frequent screening and treatment programs.
文摘A needs assessment of the knowledge, attitudes, practices, and beliefs about HIV/AIDS prevention was conducted among 100 Sudanese and Bantu Somali women immigrants aged 19 years and older, recruited through a community organization between April and July 2006. Information was collected by interview using interpreters to administer a 60-item test and a 116-item questionnaire that had been translated into Nuer and Arabic. Women in this study had low levels of education, poor knowledge about HIV transmission and prevention and safer sex practices, and poor attitudes to HIV/AIDS. They believe that HIV/AIDS is a punishment from God, HIV-positive people should be separated from society, carrying a condom indicates having loose morals, women should not experience sexual pleasure, and men should decide when and how to have sexual intercourse. Education, gender, and cultural beliefs are critical in the spread of HIV. Efforts to educate immigrant and displaced populations, particularly women, are essential.
基金the support from the start-up of the University of Missouri-Columbia。
文摘Wearable ultrasound devices represent a transformative advancement in therapeutic applications,offering noninvasive,continuous,and targeted treatment for deep tissues.These systems leverage flexible materials(e.g.,piezoelectric composites,biodegradable polymers)and conformable designs to enable stable integration with dynamic anatomical surfaces.Key innovations include ultrasound-enhanced drug delivery through cavitation-mediated transdermal penetration,accelerated tissue regeneration via mechanical and electrical stimulation,and precise neuromodulation using focused acoustic waves.Recent developments demonstrate wireless operation,real-time monitoring,and closed-loop therapy,facilitated by energy-efficient transducers and AI-driven adaptive control.Despite progress,challenges persist in material durability,clinical validation,and scalable manufacturing.Future directions highlight the integration of nanomaterials,3D-printed architectures,and multimodal sensing for personalized medicine.This technology holds significant potential to redefine chronic disease management,postoperative recovery,and neurorehabilitation,bridging the gap between clinical and home-based care.
文摘Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.
文摘As drivers age, roadway conditions may become more challenging, particularly when normal aging is coupled with cognitive decline. Driving during lower visibility conditions, such as inclement weather, is especially challenging for older drivers due to their sensitivity to glare and reduced visibility. As a result, older drivers may adjust their behavior during adverse weather. This paper explores the differential impacts of weather on older drivers with cognitive decline compared to older drivers with normal cognitive function. Data were from a naturalistic driving study of older drivers in Omaha, Nebraska. Driver speed and weather data were extracted and the correlation between speed compliance, road weather conditions, and the cognitive/neurological status of the drivers was examined. Speed compliance was used as the surrogate safety measure since driving at lower speeds can indicate that the driver is challenged by roadway or environmental conditions and can therefore indicate a risk. The percentage of time during a trip when drivers were 16.1 kph under the speed limit was modeled as the dependent variable using beta regression. The variables that resulted in the best fit model were mild cognitive impairment (MCI), age group, traffic density, and weather. Results indicated that the youngest group of older drivers (young-old) spent less time driving at impeding speeds and had the least variability compared to the other two age groups. The middle group of older drivers (middle-old) had the highest amount of time driving at impeding speeds and had more variability than young-old drivers. The oldest group of older drivers (old-old) were the most likely to drive at impeding speeds and had the most variability. In general, older drivers were more likely to drive at impeding speeds during peak hours than during non-peak hours. Additionally, in most cases, older drivers spent less time below the speed limit when the weather was clear than in adverse conditions. Results indicate that older drivers are impacted by weather conditions, and distinct patterns were noted between older drivers who were cognitively impaired compared to drivers with normal cognition.
基金supported by the National Institutes of Health(Grants P30 CA036727 and R01 CA258621)and funding from the University of Nebraska Medical Center Graduate Studies Assistantship.
文摘The unfolded protein response pathway is an evolutionarily conserved cytoprotective signaling cascade,essential for cell function and survival.Unfolded protein response signaling is tightly integrated with bone cell differentiation and function,and chronic unfolded protein response activation has been identified in bone disease.The unfolded protein response has been found to promote oncogenesis and drug resistance,raising the possibility that unfolded protein response modulators may have activity as anti-cancer agents.Cancer-associated bone disease remains a major cause of morbidity for patients with multiple myeloma or bone-metastatic disease.Understanding the critical role of unfolded protein response signaling in cancer development and metastasis,as well as its role in bone homeostasis,may lead to novel mechanisms by which to target cancer-associated bone disease.In this review,we summarize the current research delineating the roles of the unfolded protein response in bone biology and pathophysiology,and furthermore,review unfolded protein response modulating agents in the contexts of cancer and cancer-associated bone disease.
文摘Low-density lipoprotein cholesterol(LDL-C)is the most causal risk factor for atherosclerotic cardiovascular disease(ASCVD).Red yeast rice(RYR)is a nutraceutical widely used as a lipid-lowering dietary supplement.The main cholesterol-lower agents in RYR are monacolins,particularly monacolin K,a weak reversible inhibitor of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase,whose daily consumption(up to 10 mg/day)reduces LDL-C plasma levels up to 34%within 6-8 weeks when compared to placebo.The reduction in LDL-C is often accompanied by lower levels of plasma apolipoprotein B,total cholesterol,matrix metalloproteinases 2 and 9,high-sensitivity C-reactive protein,non-high-density lipoprotein cholesterol,and blood pressure.RYR has also demonstrated favorable reductions of up to 45%compared to placebo in the risk of ASCVD events in secondary prevention studies.The mechanism of action is similar to statins.When consumed appropriately,RYR is associated with only minimal side effects.Mild myalgia may be seen in patients who cannot tolerate low-dose statins.In individuals with no additional ASCVD risk factors,RYR is a safe and effective supplement in treating mild to moderate hyperlipidemia.
文摘BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.
文摘Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the left ventricular endocardial borders.Their use during echocardiography has become a valuable tool in non-invasive diagnostics.UCAs provide higher-quality images that may ultimately reduce the length of hospital stays and improve patient care.The higher cost associated with UCAs in many situations has been an impediment to frequent use.However,when used as an initial diagnostic test,UCA during rest echocardiogram is more cost-effective than the traditional diagnostic approach,which frequently includes multiple tests and imaging studies to make an accurate diagnosis.They can be easily performed across multiple patient settings and provide optimal images that allow clinicians to make sound medical decisions.This consequently allows for better diagnostic accuracies and improvement in patient care.
文摘Sinus of Valsalva aneurysm(SoVA)is a rare cardiac defect that may be congenital or acquired.It is characterized by abnormal dilatation of the aortic root due to a weakened elastic lamina at the junction of the annulus fibrosus and the aortic media.SoVAs are present in approximately 0.09%of the general population and comprise up to 3.5%of all congenital cardiac defects.It is usually found inci-dentally on cardiac imaging,with a higher incidence observed in the Western populations and a male-to-female ratio of 4:1.A transthoracic two-dimensional echocardiogram is the initial diagnostic test of choice,which may reveal the characteristic“windsock deformity”that clinches the diagnosis.Other imaging modalities,such as transesophageal echocardiography and cardiac computed tomography angiography,help provide more extensive details of the aneurysm and its adjacent structures.Management options for ruptured and unruptured SoVA include surgical repair or transcatheter closure,which serves as a game-changing development in treatment.This article aims to provide background information on the epidemiology,pathophysiology,diagnosis,and recent advan-cements over the past decade in the management of SoVAs.
文摘In general,the use of steroids is associated with three forms of liver injury that include hepatitis B reactivation,drug-induced liver injury,and steatosis/steatohepatitis.Drug-induced liver injury is a known but rare adverse effect of highdose steroids.While corticosteroids,including methylprednisolone,are generally considered safe,high doses have been linked to hepatic injury.This form of insult is often idiosyncratic and unpredictable.We present the case of a 60-year-old female who was admitted due to a 6-week history of paresthesia and weakness involving her bilateral hands and feet.Magnetic resonance imaging of the brain,cervical,and thoracic regions revealed several enhancing lesions,highly concerning for multiple sclerosis.One day following high-dose intravenous methylprednisolone,liver enzymes were found to be significantly elevated on her complete metabolic panel.Steroid therapy was discontinued,and liver enzymes returned to normal values within 4 days.Symptoms ultimately resolved following a 7-day course of plasmapheresis.This article brings attention to providers about this rare adverse effect,especially to clinical specialists who often use high-dose steroids.Suggestions regarding monitoring and treatment are also provided.
基金This work was supported by the Basic Research Top Talent Plan of Lanzhou Jiaotong University(2022JC05).
文摘Texas is the largest state by area in the US after Alaska,and one of the top states in the production and consumption of electricity with many coal-fired plants.Coal-fired power plants emit greater than 70% of pollutants in the energy sector.When coal is burned to produce electricity,nitrogen oxides(NO_(x))are released into the air,one of the main pollutants that threaten human health and lead to a large number of premature deaths.The key to effective air quality management is the strict compliance of all plants with emission standards.However,not all Texas coal plants have the environmental equipment to lower pollutant emissions.Nitrogen dioxide(NO2)observations from the TROPOspheric Monitoring Instrument(TROPOMI)were used to evaluate the emissions for Texas power plants.Data from both the Emissions and Generation Resource Integrated Database(EGRID)and the Emissions Database for Global Atmospheric Research(EDGAR)were used to examine emissions.It was found that NOx emissions for Texas power plants range from 1.53 kt/year to 10.99 kt/year,with the Martin Lake,Limestone and Fayette Power Project stations being the top emitters.WA Parish and Martin Lake stations have the strongest NOx fluxes,with both exhibiting significant seasonal variability.Comparisons of bottom-up inventories for EDGAR and EGRID show a high correlation(r=0.956)and a low root mean square error(0.766).A more reasonable control policy would lead to much reduced NOx emissions.
基金United States Department of Defense Office of the Congressionally Directed Medical Research Programs(CDMRP),Grant/Award Number:W81XWH-22-1-0176。
文摘Background:Reliable animal models are crucial to drug development for focal segmental glomerulosclerosis(FSGS),a rare kidney disease.Variability in success rates in literature and significant ethical concerns with animal welfare necessitate further optimization of adriamycin(ADR)-induced FSGS model developed on BALB/c mice.Methods:High-performance liquid chromatography(HPLC)was used to assess ADR stability in water and upon light exposure.To identify the optimal ADR level,single intravenous ADR injections with dosing levels from 10 to 17 mg/kg body weight were administered to BALB/c mice to induce FSGS-like pathology.Body weight and proteinuria of FSGS mice were monitored and analyzed for FSGS model-associated morbidity.Animals were euthanized for hematological and kidney histological assessments 8 weeks post induction.To identify the suitable experiment time frame of the ADR-induced FSGS mouse model,a longitudinal study was performed,with an 11-week continuous monitoring of the symptoms.Results:ADR was found to be unstable in aqueous media and light sensitive.A dosing level of 10.5 mg/kg of ADR was optimal for consistent FSGS mouse model induction on BALB/c strain,characterized by minimal mortality and sustained FSGS-like symptoms.Findings from the longitudinal study suggest that 6 weeks post ADR induction may represent the peak of FSGS pathology severity in this mouse model.This time frame may be used for FSGS drug development projects.Conclusion:Based on the outcome from this study,we identified the optimal ADR dosing level and model testing duration.A standard operating procedure(SOP)for the ADR-induced FSGS mouse model was established to facilitate FSGS basic research and drug development.
文摘BACKGROUND Patients and providers are often unaware of available treatment options for alcohol use disorder(AUD)and how to pursue them.AIM To improve AUD treatment rates using an educational video module(EVM).METHODS Prospective single-center cohort study evaluating the impact of a novel interactive patient EVM in promoting AUD treatment among hospitalized patients with alcohol-associated liver disease.Treatment was defined as receiving medication or participating in psychosocial treatment within 30 days of discharge.Primary outcome was change in treatment rates after viewing the EVM compared to a retrospective control cohort.Secondary outcomes were predictors of receiving treatment,EVM feedback,30-day hospital readmission,outpatient follow-up,return to alcohol use,and mortality.RESULTS Forty-two patients were included.Mean age was 45 years,50%were female,and mean model for end-stage liver disease score 15.5.After viewing the EVM,treatment rates increased for pharmacologic(50%vs 22%,P=0.0008)and psychosocial treatment(73.8%vs 44%,P=0.01).Return to alcohol use was significantly lower(7.9%vs 35.6%,P=0.003).All 100%of patients would recommend the EVM.CONCLUSION EVM allows hospitalized patients to receive standardized education about AUD treatment.This may address patient and provider knowledge gaps and reduce the growing burden of alcohol-associated liver disease.Future studies should evaluate EVM in larger patient populations using a multi-center study design.
文摘BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver cancer and liver failure,with Hepatitis B and Hepatitis C being the most common viruses associated with these outcomes.AIM To study viral hepatitis-related mortality trends from 1999 to 2022,focusing on gender,race/ethnicity,age,region,and urban/rural classifications.METHODS We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify viral hepatitis-related deaths in the United States from 1999 to 2022.Data on demographic and regional information were analyzed and stratified by gender,race/ethnicity,age,regional,and urban rural classifications.Using the Joinpoint Regression Program(version 4.9.0.0 used,available from the National Cancer Institute,Bethesda,Maryland)the annual percentage change(APC)and average APC(AAPC)were calculated with 95%CI for extracted Age Adjusted Mortality Rates(AAMR).RESULTS From 1999 to 2022,there were 389916 viral hepatitis-related deaths in the United States.The overall AAMR increased from 1999 to 2013(APC:3.20%;95%CI:2.54-3.99;P<0.001),then declined through 2022(APC:-5.54%;95%CI:-6.75 to-4.47;P<0.001).Males accounted for 70.4%of deaths,with steeper declines in females(AAPC:-0.48%;95%CI:-0.87 to-0.12;P<0.05).The American Indian/Alaska Native population had the highest AAMR(AAPC:2.90%;95%CI:2.30 to 3.68;P<0.001).The population of 65-74 years had the largest increase in overall crude mortality rate(AAPC:3.20%;95%CI:2.77 to 3.85;P<0.001).Mortality was highest in the West(AAPC:-0.78%;95%CI-1.28 to-0.29;P<0.05).Rural AAMR exceeded urban rates after 2015.CONCLUSION This study found significant racial,ethnic,and geographical disparities in viral hepatitis AAMR.Key factors for mortality reduction include patient education,screening,and access to hepatitis vaccination and treatment.
文摘In this article,we provide an important commentary on the original study Lu et al,which offers insight into the surgical efficacy of transanal total mesorectal excision(TaTME)vs laparoscopic total mesorectal excision(LapTME)in the management of low-lying locally advanced rectal cancer(LARC).We focus specifically on the rate of postoperative complications between the two using existing data from the literature.We additionally introduce robotic total mesorectal excision(RTME)and look at its postoperative complications relative to the TaTME and LapTME.LARC has been conventionally approached by open surgery.However,minimally invasive techniques have emerged over the past two decades as alternatives to open total mesorectal excision,namely robotic,laparoscopic,and transanal.Each approach has its supporters,but conflicting data on resection outcomes and complications has fueled ongoing debate over the optimal minimally invasive technique for low/mid-LARC.This article aims to extend on the data regarding the use of TaTME and RTME in the treatment of low/mid-LARC and further elaborate on their comparative efficacy relative to LapTME.
文摘Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous manifestations that may hold diagnostic and prognostic significance. Patients with BMES have reported localized erythema, dermal thickening, and induration overlying the affected joints, which are hypothesized to reflect microvascular compromise and inflammatory processes within the bone and adjacent soft tissues. Dermatologic signs are likely linked to regional hyperemia, venous stasis, and cytokine-mediated inflammation, paralleling the pathophysiological mechanisms underlying intraosseous edema. Elevated intraosseous pressure in BMES may disrupt local perfusion, resulting in ischemia-reperfusion injury and subsequent vascular leakage, which manifests in visible cutaneous changes. Pro-inflammatory mediators, such as interleukin-1β and vascular endothelial growth factor (VEGF), central to BMES pathogenesis, may exacerbate endothelial activation, and dermal involvement. Histopathologic studies of affected skin have revealed perivascular lymphocytic infiltration and increased dermal vascularity, further supporting the theory of a shared ischemic and inflammatory pathway between bone and skin. Although MRI remains the gold standard for BMES diagnosis, recognition of these cutaneous manifestations could expedite orthopedic referral and intervention, especially in cases where imaging is delayed or symptoms are ambiguous. Current treatment options, including bisphosphonates, prostacyclin analogs, and offloading of weight bearing, may benefit from integration with dermatologic strategies to alleviate localized cutaneous symptoms and improve patient comfort. Evaluating the molecular and vascular links between BMES and its cutaneous manifestations provides an opportunity to refine diagnostic protocols and therapeutic approaches, offering a comprehensive understanding of the systemic interplay between dermal and skeletal pathophysiology, and optimizing clinical outcomes for patients affected by BMES.
基金supported by NIH-NIDCD,5R01DC21070-0,and Creighton University’s Start-up funds to MZMs.Iman Ezzat was supported by the Department of Biomedical Sciences at Creighton University and the Bellucci Foundation pre-doctoral award.
文摘Integrins are heterodimeric transmembrane receptors that mediate bidirectional interactions between the intracellular cytoskeletal array and the extracellularmatrix.These interactions are critical in tissue development and function by regulating gene expression and sustaining tissue architecture.In humans,the integrin family is composed of 18 alpha(α)and 8 beta(β)subunits,constituting 24 distinctαβcombinations.Based on their structure and ligandbinding properties,only a subset of integrins,8 out of 24,recognizes the arginine-glycine-aspartate(RGD)tripeptide motif in the native ligand.One of the major RGD binding integrins is integrin alpha 8 beta 1(α8β1),a central Ras homolog gene familymemberA(RHOA)-dependentmodulator highly expressed in cells with contractile function.This review focuses on the recent advances regardingα8β1 function during organ development,with a particular interest in kidney and inner ear development.We alsodiscussα8β1’s role ininjury anddisease and its importance formesenchymal to epithelial transition during cancer development.Finally,we highlightα8β1’s importance for hearing function and its future use as a potential diagnostic and therapeutic tool for disease elimination.
基金funding support from the United States Fish and Wildlife Service,the North Carolina Wildlife Resources Commission,and the University of North Carolina at Greensboro,as part of a collective effort for the North American Bat Monitoring Program(NABat).
文摘Temperate forest ecosystems are important habitats for many bat species. However, these habitats are increasingly affected by anthropogenic disturbances, particularly urban development, leading to landscapes with varying land cover composition and configuration. Limited research has examined how forest and urban landscape composition and configuration influence bat activity and diversity. Using a multi-year statewide bat acoustic monitoring dataset from North Carolina, USA, we investigated the effects of forest and urban composition and configuration at multiple spatial scales on bat activity and diversity. First, we constructed single-variable landscape index regression models and found that both the composition and configuration of forests and urban developments influenced bat activity and diversity in a species-specific manner. Next, we applied a hierarchical partitioning approach to compare the relative contributions of composition and configuration indices in explaining variance in bat activity. For big brown bats and hoary bats, evergreen forest and urban development composition indices contributed the most to explaining activity variance. In contrast, for eastern red bats, evening bats, and tricolored bats, deciduous forest fragmentation indices describing landscape configuration were the most influential factors. Silver-haired bat activity variance was primarily explained by an evergreen forest fragmentation index. Lastly, urban development configuration indices were the strongest predictors of Mexican free-tailed bat activity and total bat activity. These results suggest that forest and urban landscape configuration should be considered in conservation and management planning for North American temperate forest ecosystems, particularly in regions that have not experienced drastic deforestation in recent decades.
