Satellite imagery as a management tool for monitoring water clarity across freshwater ponds on Cape Cod, Massachusetts.

Water clarity serves as both an indicator and a regulator of biological function in aquatic systems. Large-scale, consistent water clarity monitoring is needed for informed decision-making. Inland freshwater ponds and lakes across Cape Cod, a 100-km peninsula in Massachusetts, are of particular interest for water clarity monitoring. Secchi disk depth (SDD), a common measure of water clarity, has been measured intermittently for over 200 Cape Cod ponds since 2001. Field-measured SDD data were used to estimate SDD from satellite data, leveraging the NASA/USGS Landsat Program and Copernicus Sentinel-2 mission, spanning 1984 to 2022. Random forest machine learning models were generated to estimate SDD from satellite reflectance data and maximum pond depth. Spearman rank correlations (rs) were "strong" for Landsat 5 and 7 (rs = 0.78 and 0.79), and "very strong" for Landsat 8, 9, and Sentinel-2 (rs = 0.83, 0.86, and 0.80). Mean absolute error also indicated strong predictive capacity, ranging from 0.65 to 1.05 m, while average bias ranged from -0.20 to 0.06 m. Long- and recent short-term changes in satellite-estimated SDD were assessed for 193 ponds, selected based on surface area and the availability of maximum pond depth data. Long-term changes between 1984 and 2022 established a retrospective baseline using the Mann-Kendall test for trend and Theil-Sen slope. Generally, long-term water clarity improved across the Cape; 149 ponds indicated increasing water clarity, and 8 indicated deteriorating water clarity. Recent short-term changes between 2021 and 2022 identified ponds that may benefit from targeted management efforts using the Mann-Whitney U test. Between 2021 and 2022, 96 ponds indicated deteriorations in water clarity, and no ponds improved in water clarity. While the 193 ponds analyzed here constitute only one quarter of Cape Cod ponds, they represent 85% of its freshwater surface area, providing the most spatially and temporally comprehensive assessment of Cape Cod ponds to date. Efforts are focused on Cape Cod, but can be applied to other areas given the availability of local field data. This study defines a framework for monitoring and assessing change in satellite-estimated SDD, which is important for both local and regional management and resource prioritization.

Diversity in the Australian speech-language pathology workforce: Addressing Sustainable Development Goals 3, 4, 8, and 10.

PURPOSE: Individuals have multiple intersecting identities, unique perspectives, and experiences which provide opportunities for new ways to interact, support inclusion and equity, and address the Sustainable Development Goals (SDGs). This commentary explores the diversity of the speech-language pathology workforce in Australia. RESULT: A survey of Australian speech-language pathologists (SLPs; n = 1,638) distributed in November and December 2021 explored personal characteristics and experiences of the workforce. Almost 30% of SLPs who responded reported having experiences or perspectives that were relevant to service users and a quarter described other lived experiences, which included disability, cultural and linguistic background, mental health, caring responsibilities, neurodiversity, and being LGBTQI+. CONCLUSION: This commentary affirms the value of diversity among allied health professions to enrich practice with individuals and communities. By understanding the diversity of the speech-language pathology workforce and perspectives of historically marginalised or invisible groups, the profession can introduce strategies to more meaningfully engage and support people with diverse backgrounds and perspectives in the workforce and enhance service equity and accessibility for people with communication and swallowing disabilities. This commentary focusses on SDG 3, SDG 4, SDG 8, SDG 10.

Lost bioscapes: Floristic and arthropod diversity coincident with 12th century Polynesian settlement, Nuku Hiva, Marquesas Islands.

Knowledge of biodiversity in the past, and the timing, nature, and drivers of human-induced ecological change, is important for gaining deep time perspectives and for modern conservation efforts. The Marquesas Islands (Polynesia) are one of the world's most remote archipelagos and illustrate the vulnerability of indigenous bioscapes to anthropogenic activities. Characterised by high levels of endemism across many biotic groups, the full spectrum of the group's flora and fauna is nonetheless incompletely known. Several centuries of Polynesian settlement reshaped biotic communities in ways that are not yet fully understood, and historically-introduced mammalian herbivores have devastated the indigenous lowland flora. We report here on archaeological recovery of a diverse assemblage of plant and arthropod subfossils from a waterlogged deposit on the largest Marquesan island: Nuku Hiva. These materials offer new perspectives on the composition of lowland plant and arthropod communities pene-contemporaneous with human arrival. Bayesian analysis of multiple 14C results from short-lived materials date the assemblages to the mid-12th century AD (1129-1212 cal. AD, 95.4% HPD). Evidence for human activities in the catchment coincident with deposit formation includes Polynesian associated arthropods, microcharcoal, and an adzed timber. Plant macrofossils (seeds, fruits, vegetative structures) and microfossils (pollen, phytoliths) reveal coastal and lowland wet-moist forest communities unlike those observed today. Several apparently extinct taxa are identified, along with extant taxa currently constrained to high altitude and/or interior areas. A diverse inventory of subfossil arthropods-the first pre-18th century records for the islands-includes more than 100 distinct taxa, with several new archipelago records and one previously unreported for eastern Polynesia. The assemblages provide new insights into lowland Marquesan forest communities coincident with human arrival, and portend the considerable anthropogenic transformations that followed. These records also have implications for human colonisation of the Marquesas Islands and East Polynesia at large.

Anti-CD19 CAR T-cell therapy remission despite prior anti-CD19 antibody Tafasitamab in relapsed/refractory DLBCL.

Tafasitamab (MOR208) is an Fc-enhanced, humanized, monoclonal antibody that targets CD19. The L-MIND (NCT02399085) trial, an open-label, single-arm, phase II study of Tafasitamab (TAFA) plus lenalidomide (LEN), reported progression-free survival of 16 months in R/R DLBCL patients ineligible for autologous stem cell transplantation. Despite recent advances in anti-CD19 therapy, no clinical evidence exists to direct the sequencing of CAR T cell therapy following relapse after prior anti-CD19 therapy. We present the first published case of TAFA/LEN treatment followed by CAR T therapy with sustained remission. Disease progression following treatment with Tafasitamab may not preclude patients from CAR T cell therapy.

Beyond the pipeline: a critique of the discourse surrounding the development of an Indigenous primary healthcare workforce in Australia.

A central strategy in addressing health disparities experienced by Indigenous people has been based on a concern with workforce improvement. In this paper, the Indigenous Australian healthcare workforce literature since 1977 is reviewed and its scope of concern, as being often limited to questions of 'supply', is critiqued. The pipeline metaphor, whether used explicitly or implied, regularly focuses attention on closing the gap on Indigenous representation within the health workforce. The exception though is the discourse concerning Indigenous Health Workers (IHWs), where questions concerning the legitimacy of the role continue to abound within a workforce hierarchy where community knowledge, though shown to be crucial to culturally safe health service provision, is trumped by the other health professions whose knowledges and legitimacy are not in question. This contrast exemplifies the need to examine the working of power not just 'supply'. The pipeline metaphor is disrupted with concerns about a range of other 'gaps' - gaps in the recognition of Indigenous knowledges, in organisational structures, in governance and in self-awareness by the health professions of their whiteness. As the health system continues to measure workforce development in terms of pipeline capacity, our study questions what happens beyond the pipeline.

Precision analysis of a quantitative CT liver surface nodularity score.

PURPOSE: To evaluate precision of a software-based liver surface nodularity (LSN) score derived from CT images. METHODS: An anthropomorphic CT phantom was constructed with simulated liver containing smooth and nodular segments at the surface and simulated visceral and subcutaneous fat components. The phantom was scanned multiple times on a single CT scanner with adjustment of image acquisition and reconstruction parameters (N = 34) and on 22 different CT scanners from 4 manufacturers at 12 imaging centers. LSN scores were obtained using a software-based method. Repeatability and reproducibility were evaluated by intraclass correlation (ICC) and coefficient of variation. Using abdominal CT images from 68 patients with various stages of chronic liver disease, inter-observer agreement and test-retest repeatability among 12 readers assessing LSN by software- vs. visual-based scoring methods were evaluated by ICC. RESULTS: There was excellent repeatability of LSN scores (ICC:0.79-0.99) using the CT phantom and routine image acquisition and reconstruction parameters (kVp 100-140, mA 200-400, and auto-mA, section thickness 1.25-5.0 mm, field of view 35-50 cm, and smooth or standard kernels). There was excellent reproducibility (smooth ICC: 0.97; 95% CI 0.95, 0.99; CV: 7%; nodular ICC: 0.94; 95% CI 0.89, 0.97; CV: 8%) for LSN scores derived from CT images from 22 different scanners. Inter-observer agreement for the software-based LSN scoring method was excellent (ICC: 0.84; 95% CI 0.79, 0.88; CV: 28%) vs. good for the visual-based method (ICC: 0.61; 95% CI 0.51, 0.69; CV: 43%). Test-retest repeatability for the software-based LSN scoring method was excellent (ICC: 0.82; 95% CI 0.79, 0.84; CV: 12%). CONCLUSION: The software-based LSN score is a quantitative CT imaging biomarker with excellent repeatability, reproducibility, inter-observer agreement, and test-retest repeatability.

Imbedding Interdisciplinary Diabetes Group Visits Into a Community-Based Medical Setting.

PURPOSE: The purpose of this study was to evaluate an interdisciplinary approach and test the efficacy of diabetes group visits tailored to low-income patients in a community-based medical practice. METHODS: A randomized repeated measures design was used with 40 patients in the experimental group and 40 patients in the control group. The diabetes group visit consisted of individualized sessions with a physician or nurse practitioner to review medications and conduct a medical examination and group sessions to deliver diabetes self-management education. Data collected included clinical data and questionnaires. A control group shared comparable demographic characteristics, medication regimens, and baseline A1C levels. RESULTS: The patients in the experimental group decreased their A1C, triglycerides, and heart rate from time 1 to time 5 and maintained their high-density lipoprotein significantly more than the control group. In exit interviews, the patients said that the group diabetes visits helped them be more accountable about their diabetes self-management goals. CONCLUSIONS: Diabetes group visits that combined diabetes self-management education and a medical visit with a health care provider improved A1C and were well received by the patients. The study provided patients with a quality program in an environment in which they felt safe to learn and that met them where they were in their diabetes self-management behaviors. This approach could be widely disseminated into other clinic settings that serve patients with type 2 diabetes.

Predictors of quality of life in patients with implantable cardioverter defibrillators.

Few studies have prospectively examined characteristics of implantable cardioverter defibrillator (ICD) patients as predictors of postimplant outcome. In this study the authors considered the association between preimplant psychological characteristics, ICD shocks, and postimplant quality of life at short- and long-term follow-ups, controlling for age and ejection fraction (N=88). Hierarchical regression analyses revealed that history of depression, trait anxiety, optimism, social support, and ICD shocks accounted for 41.8% to 64.5% of the variance in quality of life indices at 8- and 14-month follow-ups, depending on the outcome assessed. Further, psychological variables were as strong as, or stronger than, age, ejection fraction, and ICD shocks in predicting quality of life outcomes.

Do positive health expectations and optimism relate to quality-of-life outcomes for the patient with an implantable cardioverter defibrillator?

PURPOSE: Clinical trials with the implantable cardioverter defibrillator (ICD) have demonstrated desirable outcomes in terms of mortality and morbidity among patients with potentially lethal arrhythmias. This study examined the "resilience factors" of positive health expectations and global optimism prospectively using the general quality-of-life (QOL) scores of newly implanted ICD patients. METHODS: The study enrolled 88 newly implanted ICD patients (mean age, 65.3 +/- 13.2 years; 83% male; 92% white) assessed 8 and 14 months after ICD implantation. A series of 2 x 2 factorial multivariate analyses of covariance were performed to examine the differences between baseline low versus high positive health expectations and baseline low versus high optimism in short- and long-term general QOL scores. RESULTS: After control was used for ejection fraction (mean, 31%), the patients with baseline high positive health expectations reported better general health at a long-term follow-up assessment (P = .002). The patients with high optimism reported better mental health and social functioning at a short-term follow-up assessment (P =. 056), and this finding approached significance at a long-term follow-up assessment (P = .061). CONCLUSIONS: Positive health expectations and optimism are differentially related to various components of QOL. Collectively, these two resilience factors may be targeted in future studies of interventions to improve QOL for ICD patients.