Occupational Therapy in Carceral Settings: Qualitative Study of Practitioner Experiences and Perspectives.

Scant evidence exists regarding occupational therapy in carceral settings. Exploring perspectives and experiences to understand current practices is needed. To explore how occupational therapy practitioners (OTPs) navigate evaluation, interventions, and role delineation. Qualitative study using phenomenological and hermeneutic approaches Data gathered through semistructured interviews with seven OTPs with average experience of 16 months, representing six states and four practice settings. Themes were identified by two independent coders who analyzed the data with consensus by third researcher. Four themes emerged: managing contextual challenges, interpersonal professional relationships, evidence-informed services, and client-focused care. Practitioners applied various frames of reference, utilized self-report and observation evaluation methods, and implemented holistic direct and indirect interventions. Understanding and supporting the value of therapeutic relationships, activity/occupational performance analysis, and foci of occupational therapy (OT) domains and processes that emphasize indirect roles can further define and highlight the distinctive nature of OT within carceral settings.

Occupational Therapy Practice in the Carceral SystemResearch indicates occupational therapy practitioners (OTPs) have the skills to support individuals during incarceration and community re-entry. However, practice evidence for occupational therapy (OT) in carceral settings is limited as it is still an emerging practice area. To understand current practices, it is important to identify how OTPs define their role and reason about their clients and the services they provide. Seven OTPs spread across six states in various carceral settings were interviewed. Analysis of responses revealed four themes: managing contextual and interpersonal challenges, interpersonal professional relationships, evidence-informed services, and client-focused care. This study also identified that OTPs apply various theories and frames of reference and use client self-report assessment tools and observation during evaluations to provide a holistic client profile. Ongoing advocacy, staff training, and trauma-informed interventions that can flex as needed are essential. Results suggest the OTPs' reasoning processes are highly complex and align with OT professional reasoning literature.

Strong doping reduction on wafer-scale CVD graphene devices via Al2O3ALD encapsulation.

We present the electrical characterization of wafer-scale graphene devices fabricated with an industrially-relevant, contact-first integration scheme combined with Al2O3encapsulation via atomic layer deposition. All the devices show a statistically significant reduction in the Dirac point position,Vcnp, from around +47 V to between -5 and 5 V (on 285 nm SiO2), while maintaining the mobility values. The data and methods presented are relevant for further integration of graphene devices, specifically sensors, at the back-end-of-line of a standard CMOS flow.

Toward Culturally Responsive Mentoring of Muslim Research Mentees in the Sciences.

Research experiences are an integral part of training future scientists and fostering diversity in science. Providing culturally responsive research mentorship, defined as mentorship that incorporates cultural knowledge to improve learning experiences for a particular group, is a critical step in this endeavor. While culturally responsive mentoring is most commonly associated with mentoring students with underrepresented races and ethnicities in the sciences, it can also be helpful for mentees with a diversity of abilities, sexualities, economic backgrounds, and religions. In this essay, we discuss how mentors can provide more culturally responsive mentoring of Muslim research mentees in the sciences. Muslims are a stigmatized minority group in the United States who participate in a religious culture that often differs from the secular culture of science. Notably, there are few resources for how to engage in culturally responsive mentoring of Muslim research mentees. To address this gap, we drew from the extant literature on the challenges that Muslims encounter in the United States, which likely extends to the context of scientific research, and identified potential culturally responsive accommodations in research.

Non-STEM majors COVID-19 vaccine impressions improve, and misconceptions resolve, after podcast assignment.

Misinformation regarding vaccine science decreased the receptiveness to COVID-19 vaccines, exacerbating the negative effects of the COVID-19 pandemic on society. To mitigate the negative societal impact of the COVID-19 pandemic, impactful and creative science communication was needed, yet little research has explored how to encourage COVID-19 vaccine acceptance and address misconceptions held by non-Science, Technology, Engineering and Mathematics majors (referred to as non-majors). We have previously demonstrated that including expert guest lectures in the vaccine module in the non-major introductory biology course helps combat students' vaccine hesitancy. In the present study, we further address how learning about vaccines impacts student knowledge and impressions of the COVID-19 vaccines through a podcast assignment. As a part of this assignment, non-majors created podcasts to address COVID-19 vaccine misconceptions of their choice. We coded pre and post, open-ended essay reflections (n = 40) to assess non-majors' knowledge and impressions of the COVID-19 vaccines. Non-majors' impressions of the vaccines improved following the podcast assignment with more than three times as many students reporting a positive view of the assignment than negative views. Notably, eight of the nine interviewed students still ended the course with misconceptions about the COVID-19 vaccines, such as the vaccines being unnecessary or causing fertility issues. In a post semi-structured interview following this assignment, students (n = 7) discussed the impact of looking into the specific misconceptions related to COVID-19 vaccines themselves, including improved science communication skills and understanding of different perspectives. Thus, podcasts can provide opportunities for students to improve engagement in valuable societal topics like vaccine literacy in the non-majors classroom.

Christian Student Experiences During Peer Interactions in Undergraduate Biology Courses.

The tension between religion and science as a long-standing barrier to science education has led researchers to explore ways of improving the experiences of Christian students in biology who can experience their Christianity as stigmatized in academic biology environments. As undergraduate science classes become student-centered, interactions among students increase, and Christians may feel a need to conceal their religious identities during peer discussions. In this interview study, we used the social psychology framework of concealable stigmatized identities to explore 30 Christian students' experiences during peer interactions in undergraduate biology courses to find potential ways to improve those experiences. We found that students felt their religious identity was salient during peer interactions in biology, and students thought revealing their religious identity to peers in their biology courses could be beneficial, yet few actually did so. Additionally, though most students anticipated stigma, comparatively few had experienced stigma from other students in their biology courses, despite the prior documented cultural stigma against Christians in biology. These results indicate a need for future studies exploring the impact of learning environments in which students are given the opportunity to share their religious identities with one another, which could reduce their anticipated and perceived stigma.

"It's More Of A Me-Thing Than An Evolution Thing": Exploring The Validity Of Evolution Acceptance Measures Using Student Interviews.

Researchers who study student acceptance of evolution rely on surveys that are designed to measure evolution acceptance. It is important for these surveys to measure evolution acceptance accurately and in isolation from other constructs, so that researchers can accurately determine what leads to low acceptance. The Inventory of Student Evolution Acceptance (I-SEA) and the Generalized Acceptance of EvolutioN Evaluation (GAENE) are two surveys that were developed to improve upon the limitations of earlier surveys. Yet neither survey has been extensively tested for response process validity, which can assess the extent to which students use constructs other than their acceptance of evolution to answer survey items. In this study, we examined the response-process validity of the I-SEA and GAENE by conducting cognitive interviews with 60 undergraduate students. Interviews revealed that both surveys retain certain response-process issues. The I-SEA conflated knowledge about and acceptance of evolution for a subset of students. The GAENE measured evolution acceptance inconsistently because students interpreted "evolution" in different ways; it also measured willingness to advocate for evolution in addition to acceptance. Researchers can use these findings to better inform their survey choice when designing future studies, and to further improve the measurement of evolution acceptance.

Exploring Black Undergraduate Students' Communication and Biology Education Experiences about COVID-19 and COVID-19 Vaccines During the Pandemic.

Effective communication about science is a core skill undergraduates should learn, but little research has explored how students communicate about culturally controversial science topics. In this study, we explored how Black undergraduate science students took on the role of science communicators in their communities during the COVID-19 pandemic. We interviewed 23 Black students about their experiences learning about COVID-19 vaccines and communicating about COVID-19 vaccines to their communities. We found that students' racial/ethnic and science backgrounds made them feel a responsibility to be effective communicators about COVID-19 vaccines as potential trusted messengers within their communities. However, students were using limited strategies when communicating and were unsure how to communicate about COVID-19 topics effectively to those who were vaccine-hesitant or doubted the severity of the pandemic. Finally, students described ways that their biology instructors could have helped them be more confident when communicating about COVID-19 vaccines with their communities. Findings suggest that biology instructors could teach science communication principles in addition to content knowledge about culturally controversial science topics in their undergraduate classes to build on students' developing science communication skills.

Fourier transform infrared spectroscopy as a non-destructive method for analysing herbarium specimens.

Dried plant specimens stored in herbaria are an untapped treasure chest of information on environmental conditions, plant evolution and change over many hundreds of years. Owing to their delicate nature and irreplaceability, there is limited access for analysis to these sensitive samples, particularly where chemical data are obtained using destructive techniques. Fourier transform infrared (FTIR) spectroscopy is a chemical analysis technique which can be applied non-destructively to understand chemical bonding information and, therefore, functional groups within the sample. This provides the potential for understanding geographical, spatial and species-specific variation in plant biochemistry. Here, we demonstrate the use of mid-FTIR microspectroscopy for the chemical analysis of Drosera rotundifolia herbarium specimens, which were collected 100 years apart from different locations. Principal component and hierarchical clustering analysis enabled differentiation between three main regions on the plant (lamina, tentacle stalk and tentacle head), and between the different specimens. Lipids and protein spectral regions were particularly sensitive differentiators of plant tissues. Differences between the different sets of specimens were smaller. This study demonstrates that relevant information can be extracted from herbarium specimens using FTIR, with little impact on the specimens. FTIR, therefore, has the potential to be a powerful tool to unlock historic information within herbaria.

Effect of subclinical endometritis and flunixin meglumine administration on pregnancy in embryo recipient beef cows.

Fertility of recipient beef cows with subclinical endometritis (SCE) that did or did not receive flunixin meglumine (FM) treatment were compared following transfer of d 7 embryo. The study population comprised of 600 Angus cross cows that expressed estrus following Select-Synch + CIDR (Controlled Internal Drug Release) estrus synchronization protocol. At the time of embryo transfer, approximately 3 wk after sampling for subclinical endometritis, cows were randomly allocated either to receive FM treatment (500 mg of Banamine®; n = 300) or not (Control; n = 300). The effect of subclinical endometritis (at ≥ 1% PMN on endometrial cytology by cytobrush method) and FM treatment on pregnancy/embryo transfer (P/ET, %) were evaluated by mixed model. Of the 600 cows, 323 (53.8%) became pregnant; 55.0% (165/300) cows that received FM treatment vs. 52.7% (158/300) control cows (P > 0.1), and 55.9% (266/476) normal vs. 46.0% (57/124) subclinical endometritis cows (P < 0.05). There was a trend for treatment by subclinical endometritis for P/ET (P = 0.09). Pregnancy was recorded in 55.3% (134/242) of normal and 53.4% (31/58) of subclinical endometritis cows that received FM treatment, and in 56.4% (132/234) of normal and 39.4% (26/66) of subclinical endometritis cows that did not receive FM treatment (P = 0.09). In conclusion, subclinical endometritis in recipient beef cows resulted in lower P/ET. Though not significant in cows with subclinical endometritis, FM treatment resulted in 14.0% points more pregnancy compared with control.

A Comparison of Online and In-Person Evolution Instruction That Includes Religious Cultural Competence.

Evolution is one of the most important concepts in biology, but it is rejected by a substantial percentage of religious students due to a perceived conflict with their religious beliefs. The use of religious cultural competence in evolution education (ReCCEE) has been shown to effectively increase evolution acceptance among religious students during in-person instruction, but there is no research that we know of that indicates the effectiveness of these practices during online instruction. In this study, we explored the efficacy of online culturally competent practices for religious students on students' evolution understanding, evolution acceptance, and comfort learning evolution at a religious university. Before and after evolution instruction, we surveyed 178 students in online introductory biology courses and compared these student outcomes to 201 students in the same instructor's in-person introductory biology courses. We found that evolution acceptance and understanding increased in online classes with culturally competent practices, and these gains were similar to those observed in the in-person courses. Despite these similarities, we found that students were more comfortable learning evolution in person than online, but this difference was small. Our findings suggest that the use of culturally competent practices online can be as effective as their use for in-person instruction for improving students' attitudes toward evolution, but in-person instruction may be more effective for cultivating students' comfort while learning evolution.

SyncMRT: a solution to image-guided synchrotron radiotherapy for quality assurance and pre-clinical trials.

In this work, a new image guidance system and protocols for delivering image-guided radiotherapy (IGRT) on the Imaging and Medical Beamline (IMBL) at the ANSTO Australian Synchrotron are introduced. The image guidance methods used and the resulting accuracy of tumour alignment in in vivo experiments are often under-reported. Image guidance tasks are often complex, time-consuming and prone to errors. If unchecked, they may result in potential mis-treatments. We introduce SyncMRT, a software package that provides a simple, image guidance tool-kit for aligning samples to the synchrotron beam. We have demonstrated sub-millimetre alignment using SyncMRT and the small-animal irradiation platform (the DynamicMRT system) on the IMBL. SyncMRT has become the standard for carrying out IGRT treatments on the IMBL and has been used in all pre-clinical radiotherapy experiments since 2017. Further, we introduce two quality assurance (QA) protocols to synchrotron radiotherapy on the IMBL: the Winston-Lutz test and hidden target test. It is shown that the presented QA tests are appropriate for picking up geometrical setup errors and assessing the end-to-end accuracy of the image guidance process. Together, these tools make image guidance easier and provide a mechanism for reporting the geometric accuracy of synchrotron-based IGRT treatments. Importantly, this work is scalable to other delivery systems, and is in continual development to support the upcoming veterinary radiotherapy trials on the IMBL.

Expert-Led Module Improves Non-STEM Undergraduate Perception of and Willingness to Receive COVID-19 Vaccines.

As evidence mounted that existing prevention methods would be insufficient to end the COVID-19 pandemic, it became clear that vaccines would be critical to achieve and maintain reduced rates of infection. However, vaccine-hesitant sentiments have become widespread, particularly in populations with lower scientific literacy. The non-STEM major (called non-major) college students represent one such population who rely on one or more science classes to develop their scientific literacy and thus, become candidates of interest for the success of the COVID-19 vaccine campaign. As these students have fewer opportunities to learn how to identify reputable scientific sources or judge the validity of novel scientific findings, it is particularly important that these skills are included in the science courses offered to non-majors. Two concurrent non-major biology courses (N = 98) at the University of Alabama at Birmingham in Spring 2021 completed Likert questionnaires with open-ended questions prior to and after an expert-led Vaccine Awareness educational intervention addressing vaccine-related concerns. In the module, experts gave presentations about COVID-19 related to microbiology, epidemiological factors, and professional experiences relating to COVID-19. Ten students agreed to participate in post-semester one-on-one interviews. Student interviews revealed that students perceived guest lecturers as providing more information and assurance. Questionnaire data showed an increase in student willingness to accept a COVID-19 vaccine as well as increased student perception of the COVID-19 vaccines as both safe and effective (Wilcoxon Rank Sum Test, p < 0.05). However, the questionnaire data revealed 10 of 98 students remained vaccine-resistant, and these students expressed insufficient research and side effects as leading vaccination concerns. Overall, we show expert-led modules can be effective in increasing non-majors willingness to accept COVID-19 vaccines. Future research should explore the experiences of non-majors and guest lectures, particularly as they relate to vaccination and vaccine concerns.

Community College Student Understanding and Perceptions of Evolution.

Learning about evolution is a foundational part of biology education, but most current studies that explore college student evolution education are conducted at universities. However, community college students tend to be more diverse in characteristics shown to be related to evolution education outcomes. To explore how studies involving university students may generalize to community college students, we surveyed students from seven community college (n = 202) and nine university (n = 2288) classes. We measured students' evolution interest, acceptance, and understanding, and for religious students, we measured their perceived conflict between their religions and evolution. Controlling for state and major, we found that community college students had similar levels of evolution interest as university students but perceived greater conflict between their religions and evolution. Further, community college students had lower evolution understanding and acceptance compared with university students. Religiosity was a strong factor predicting community college and university students' evolution acceptance. However, unique to community college students, evolution understanding was not related to their macroevolution or human evolution acceptance. This indicates that, although some results between community college and university students are similar, there are differences that have implications for evolution instruction that warrant the need for more evolution education research at community colleges.

Structural Characterization of the D179N and D179Y Variants of KPC-2 ß-Lactamase: Ω-Loop Destabilization as a Mechanism of Resistance to Ceftazidime-Avibactam.

Klebsiella pneumoniae carbapenemases (KPC-2 and KPC-3) present a global clinical threat, as these ß-lactamases confer resistance to carbapenems and oxyimino-cephalosporins. Recent clinically identified KPC variants with substitutions at Ambler position D179, located in the Ω loop, are resistant to the ß-lactam/ß-lactamase inhibitor combination ceftazidime-avibactam, but susceptible to meropenem-vaborbactam. To gain insights into ceftazidime-avibactam resistance conferred by D179N/Y variants of KPC-2, crystal structures of these variants were determined. The D179N KPC-2 structure revealed that the change of the carboxyl to an amide moiety at position 179 disrupted the salt bridge with R164 present in wild-type KPC-2. Additional interactions were disrupted in the Ω loop, causing a decrease in the melting temperature. Shifts originating from N179 were also transmitted toward the active site, including ∼1-Å shifts of the deacylation water and interacting residue N170. The structure of the D179Y KPC-2 ß-lactamase revealed more drastic changes, as this variant exhibited disorder of the Ω loop, with other flanking regions also being disordered. We postulate that the KPC-2 variants can accommodate ceftazidime because the Ω loop is displaced in D179Y or can be more readily displaced in D179N KPC-2. To understand why the ß-lactamase inhibitor vaborbactam is less affected by the D179 variants than avibactam, we determined the crystal structure of D179N KPC-2 in complex with vaborbactam, which revealed wild-type KPC-2-like vaborbactam-active site interactions. Overall, the structural results regarding KPC-2 D179 variants revealed various degrees of destabilization of the Ω loop that contribute to ceftazidime-avibactam resistance, possible substrate-assisted catalysis of ceftazidime, and meropenem and meropenem-vaborbactam susceptibility.

An exploration of how gender, political affiliation, or religious identity is associated with comfort and perceptions of controversial topics in bioethics.

Bioethics is an important aspect of understanding the relationship between science and society, but studies have not yet examined undergraduate student experiences and comfort in bioethics courses. In this study, we investigated undergraduate bioethics students' support of and comfort when learning three controversial bioethics topics: gene editing, abortion, and physician-assisted suicide (PAS). Furthermore, student identity has been shown to influence how students perceive and learn about controversial topics at the intersection of science and society. So, we explored how students' religious affiliation, gender, or political affiliation was associated with their support of and comfort when learning about gene editing, abortion, and PAS. We found that most students entered bioethics with moderated viewpoints on controversial topics but that there were differences in students' tendency to support each topic based on their gender, religion, and political affiliation. We also saw differences in student comfort levels based on identity: women reported lower comfort than men when learning about gene editing, religious students were less comfortable than nonreligious students when learning about abortion and PAS, and nonliberal students were less comfortable than liberal students when learning about abortion. Students cited that the controversy surrounding these topics and a personal hesitancy to discuss them caused discomfort. These findings indicate that identity impacts comfort and support in a way similar to that previously shown in the public. Thus, it may be important for instructors to consider student identity when teaching bioethics topics to maximize student comfort, ultimately encouraging thoughtful consideration and engagement with these topics.

A Revised Measure of Acceptance of the Theory of Evolution: Introducing the MATE 2.0.

Hundreds of articles have explored the extent to which individuals accept evolution, and the Measure of Acceptance of the Theory of Evolution (MATE) is the most often used survey. However, research indicates the MATE has limitations, and it has not been updated since its creation more than 20 years ago. In this study, we revised the MATE using information from cognitive interviews with 62 students that revealed response process errors with the original instrument. We found that students answered items on the MATE based on constructs other than their acceptance of evolution, which led to answer choices that did not fully align with their actual acceptance. Students answered items based on their understanding of evolution and the nature of science and different definitions of evolution. We revised items on the MATE, conducted 29 cognitive interviews on the revised version, and administered it to 2881 students in 22 classes. We provide response process validity evidence for the new measure through cognitive interviews with students, structural validity through a Rasch dimensionality analysis, and concurrent validity evidence through correlations with other measures of evolution acceptance. Researchers can now measure student evolution acceptance using this new version of the survey, which we have called the MATE 2.0.

A comparison study of human examples vs. non-human examples in an evolution lesson leads to differential impacts on student learning experiences in an introductory biology course.

BACKGROUND: Instructors can teach evolution using any number of species contexts. However, not all species contexts are equal, and taxa choice can alter both cognitive and affective elements of learning. This is particularly true when teaching evolution using human examples, a promising method for evolution instruction that nevertheless comes with unique challenges. In this study, we tested how an evolution lesson focused on a human example may impact students' engagement, perceived content relevance, learning gains, and level of discomfort, when compared to the same lesson using a non-human mammal example. We use this isomorphic lesson and a pre-post study design administered in a split-section introductory biology classroom to isolate the importance of the species context. RESULTS: For two of the four measurements of interest, the effect of using human examples could not be understood without accounting for student background. For learning gains, students with greater pre-class content knowledge benefited more from the human examples, while those with low levels of knowledge benefited from the non-human example. For perceived relevance, students who were more accepting of human evolution indicated greater content relevance from the human example. Regardless of condition, students with lower evolution acceptance reported greater levels of discomfort with the lesson. CONCLUSIONS: Our results illustrate the complexities of using human examples to teach evolution. While these examples were beneficial for many students, they resulted in worse outcomes for students that were less accepting of evolution and those who entered the course with less content knowledge. These findings demonstrate the need to consider diverse student backgrounds when establishing best practices for using human examples to teach evolution. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12052-021-00148-w.

Muslim undergraduate biology students' evolution acceptance in the United States.

Evolution is a prominent component of biology education and remains controversial among college biology students in the United States who are mostly Christian, but science education researchers have not explored the attitudes of Muslim biology students in the United States. To explore perceptions of evolution among Muslim students in the United States, we surveyed 7,909 college students in 52 biology classes in 13 states about their acceptance of evolution, interest in evolution, and understanding of evolution. Muslim students in our sample, on average, did not agree with items that measured acceptance of macroevolution and human evolution. Further, on average, Muslim students agreed, but did not strongly agree with items measuring microevolution acceptance. Controlling for gender, major, race/ethnicity, and international status, we found that the evolution acceptance and interest levels of Muslim students were slightly higher than Protestant students and students who are members of the Church of Jesus Christ of Latter-day Saints. However, Muslim student evolution acceptance levels were significantly lower than Catholic, Jewish, Buddhist, and Hindu students as well as students who did not identify with a religion (agnostic and atheists). Muslim student understanding of evolution was similar to students from other affiliations, but was lower than agnostic and atheist students. We also examined which variables are associated with Muslim student acceptance of evolution and found that higher understanding of evolution and lower religiosity are positive predictors of evolution acceptance among Muslim students, which is similar to the broader population of biology students. These data are the first to document that Muslim students have lower acceptance of evolution compared to students from other affiliations in undergraduate biology classrooms in the United States.

A New Measure of Students' Perceived Conflict between Evolution and Religion (PCoRE) Is a Stronger Predictor of Evolution Acceptance than Understanding or Religiosity.

Evolution is controversial among students and religiosity, religious affiliation, understanding of evolution, and demographics are predictors of evolution acceptance. However, quantitative research has not explored the unique impact of student perceived conflict between their religion and evolution as a major factor influencing evolution acceptance. We developed an instrument with validity evidence called "Perceived Conflict between Evolution and Religion" (PCoRE). Using this measure, we find that, among students in 26 biology courses in 11 states, adding student perceived conflict between their religion and evolution to linear mixed models more than doubled the capacity of the models to predict evolution acceptance compared with models that only included religiosity, religious affiliation, understanding of evolution, and demographics. Student perceived conflict between evolution and their religion was the strongest predictor of evolution acceptance among all variables and mediated the impact of religiosity on evolution acceptance. These results build upon prior literature that suggests that reducing perceived conflict between students' religious beliefs and evolution can help raise evolution acceptance levels. Further, these results indicate that including measures of perceived conflict between religion and evolution in evolution acceptance studies in the future is important.

Defining trajectories of response in patients with psoriasis treated with biologic therapies.

BACKGROUND: The effectiveness and cost-effectiveness of biologic therapies for psoriasis are significantly compromised by variable treatment responses. Thus, more precise management of psoriasis is needed. OBJECTIVES: To identify subgroups of patients with psoriasis treated with biologic therapies, based on changes in their disease activity over time, that may better inform patient management. METHODS: We applied latent class mixed modelling to identify trajectory-based patient subgroups from longitudinal, routine clinical data on disease severity, as measured by the Psoriasis Area and Severity Index (PASI), from 3546 patients in the British Association of Dermatologists Biologics and Immunomodulators Register, as well as in an independent cohort of 2889 patients pooled across four clinical trials. RESULTS: We discovered four discrete classes of global response trajectories, each characterized in terms of time to response, size of effect and relapse. Each class was associated with differing clinical characteristics, e.g. body mass index, baseline PASI and prevalence of different manifestations. The results were verified in a second cohort of clinical trial participants, where similar trajectories following the initiation of biologic therapy were identified. Further, we found differential associations of the genetic marker HLA-C*06:02 between our registry-identified trajectories. CONCLUSIONS: These subgroups, defined by change in disease over time, may be indicative of distinct endotypes driven by different biological mechanisms and may help inform the management of patients with psoriasis. Future work will aim to further delineate these mechanisms by extensively characterizing the subgroups with additional molecular and pharmacological data.