Toolbox of individual-level interventions against online misinformation.

The spread of misinformation through media and social networks threatens many aspects of society, including public health and the state of democracies. One approach to mitigating the effect of misinformation focuses on individual-level interventions, equipping policymakers and the public with essential tools to curb the spread and influence of falsehoods. Here we introduce a toolbox of individual-level interventions for reducing harm from online misinformation. Comprising an up-to-date account of interventions featured in 81 scientific papers from across the globe, the toolbox provides both a conceptual overview of nine main types of interventions, including their target, scope and examples, and a summary of the empirical evidence supporting the interventions, including the methods and experimental paradigms used to test them. The nine types of interventions covered are accuracy prompts, debunking and rebuttals, friction, inoculation, lateral reading and verification strategies, media-literacy tips, social norms, source-credibility labels, and warning and fact-checking labels.

Engaging the dismissive: An assessment of humor-based strategies to support global warming action.

This study aims to understand the influence of mirth, anger, and hope, as elicited by messages with different humor types, on support for global warming action, and the potential moderating role of individual climate concern. Although mirth did not significantly vary across the different stimuli, the analysis found that climate concern moderated the influence of hope on support for global warming actions. The implications of these findings, especially for respondents who were least supportive of actions to combat global warming, are discussed.

Co-Designing a Mobile-Based Game to Improve Misinformation Resistance and Vaccine Knowledge in Uganda, Kenya, and Rwanda.

Misinformation can decrease public confidence in vaccines, and reduce vaccination intent and uptake. One strategy for countering these negative impacts comes from inoculation theory. Similar to biological vaccination, inoculation theory posits that exposure to a weakened form of misinformation can develop cognitive immunity, reducing the likelihood of being misled. Online games offer an interactive, technology-driven, and scalable solution using an active form of inoculation that engages and incentivizes players to build resilience against misinformation. We document the development of the critical thinking game Cranky Uncle Vaccine. The game applies research findings from inoculation theory, critical thinking, humor in science communication, and serious games. The game content was iterated through a series of co-design workshops in Kampala (Uganda), Kitale (Kenya), and Kigali (Rwanda). Workshop participants offered feedback on cartoon character design, gameplay experience, and the game's content, helping to make the game more culturally relevant and avoid unintended consequences in East African countries. Our co-design methodology offers an approach for further adaptation of the Cranky Uncle Vaccine game to other regions, as well as a template for developing locally relevant interventions to counter future infodemics.

What motivates people to defend science: Evidence from the 2017 March for science.

The 2017 March for Science was an international march organized in response to concerns over the Trump administration's misuse of science that drew unprecedented numbers of supporters as well as attention from the media, celebrities, and political figures. The March's turnout and publicity begs the question: what motivates people to defend science? Using data from a survey of March for Science listserv members in the US, we used a structural equation model to test posited relationships between self- and collective response efficacy, perceived threat, anger, fear, and the intention to engage in advocacy to defend science. We found that each of these constructs were associated with the intention to engage in advocacy, illuminating the motivators that lead to this intention and how individuals may be activated to engage on behalf of science in the future. These insights have both theoretical and practical significance, as advocacy is integral for both supporting and advancing fact-based policy- and decision-making.

Misinformation and the epistemic integrity of democracy.

Democracy relies on a shared body of knowledge among citizens, for example trust in elections and reliable knowledge to inform policy-relevant debate. We review the evidence for widespread disinformation campaigns that are undermining this shared knowledge. We establish a common pattern by which science and scientists are discredited and how the most recent frontier in those attacks involves researchers in misinformation itself. We list several ways in which psychology can contribute to countermeasures.

Association between Prepartum Alerts Generated Using a Commercial Monitoring System and Health and Production Outcomes in Multiparous Dairy Cows in Five UK Herds.

Identifying cows that are at greater risk for disease prior to calving would be a valuable addition to transition management. Prior to the commercial release of software features in an automated behavioral monitoring system, designed to identify cows in the dry period at greater risk of disease postpartum, a retrospective analysis was carried out in five dairy herds to evaluate whether the software could identify prepartum cows that subsequently received health treatments postpartum and whether prepartum alerts (transition alerts) are associated with a reduction in milk production in the subsequent lactation. Herd management and production records were analyzed for cows receiving treatment in the first 21 d of lactation (days in milk, DIM) for clinical mastitis, reproductive tract disease (metritis, retained fetal membranes), metabolic disease (hypocalcemia, ketosis and displaced abomasum) and for cows exiting the herd by 60 DIM. Data was gathered for 986 cows, 382 (38.7%) of which received a transition alert and 604 (61.3%) that did not. During the first 21 DIM 312 (31.6%) cows went on to receive a disease treatment, of these 51.9% (n = 162/312) were transition alert cows and 48.1% (n = 150/312) non-transition alert cows, while 8.6% (n = 33/382) alert cows exited the herd by 60 DIM compared to 4.8% (n = 29/604) of cows that did not receive an alert. A cow receiving a transition alert (OR = 1.76, 95% confidence interval (CI) = 1.27-2.44) and increasing parity (OR = 2.03, 95% CI = 1.44-2.86) were both associated with increased risk of receiving a disease treatment in the first 21 DIM. The occurrence of a transition alert was negatively associated with both week 4 milk yield (daily average yield in fourth week of lactation) and predicted 305 d yield. Transition alerts correctly predicted 62.5% (95% CI: 59.3-65.5) of treatments with a sensitivity of 42.4% (95% CI: 37.4-45.5) and a specificity of 75.2% (95% CI: 71.5-78.6). Associations were identified between postpartum health and production outcomes and prepartum behavioral measures from an automated activity monitoring system.

Development and Validation of an Abbreviated Child and Adult Food Security Scale for Use in Clinical and Research Settings in the United States.

BACKGROUND: Food insecurity (FI) prevalence was consistently >10% over the past 20 years, indicating chronic economic hardship. Recession periods exacerbate already high prevalence of FI, reflecting acute economic hardship. To monitor FI and respond quickly to changes in prevalence, an abbreviated food security scale measuring presence and severity of household FI in adults and children is needed. OBJECTIVE: Our aim was to develop an abbreviated, sensitive, specific, and valid food security scale to identify severity levels of FI in households with children. DESIGN: Cross-sectional and longitudinal survey data were analyzed for years 1998 to 2022. PARTICIPANTS/SETTING: Participants were racially diverse primary caregivers of 69,040 index children younger than 4 years accessing health care in 5 US cities. STATISTICAL ANALYSES PERFORMED: Sensitivity, specificity, positive and negative predictive values, accuracy, and area under the receiver operator curve were used to test combinations of questions for the most effective abbreviated scale to assess levels of severity of adult and child FI compared with the Household Food Security Survey Module. Adjusted logistic regression models assessed convergent validity between the Abbreviated Child and Adult Food Security Scale (ACAFSS) and health measures. McNemar tests examined the ACAFSS performance in times of acute economic hardship. RESULTS: The ACAFSS exhibited 91.2% sensitivity; 99.6% specificity; 98.3% and 97.6% positive and negative predictive values, respectively; 97.7% accuracy; and a 99.6% area under the receiver operator curve, while showing high convergent validity. CONCLUSIONS: The ACAFSS is highly sensitive, specific, and valid for detecting severity levels of FI among racially diverse households with children. The ACAFSS is recommended as a stand-alone scale or a follow-up scale after households with children screen positive for FI risk. The ACAFSS is also recommended for planning interventions and evaluating their effects not only on the binary categories of food security and FI, but also on changes in levels of severity, especially when rapid decision making is crucial.

Risk factors for ultrasound-diagnosed endometritis and its impact on fertility in Scottish dairy cattle herds.

BACKGROUND: The aim of this study was to investigate the risk factors for and the impact of ultrasound-diagnosed endometritis (UDE) on lactating dairy cows' reproductive performance. METHODS: Data were analysed from 1123 Holstein and Holstein-Friesian cows from two Scottish dairy farms. A reproductive ultrasound examination was conducted on two occasions, at 43 ± 3 and 50 ± 3 days in milk (DIM), to screen for hyperechoic fluid in the uterus. Statistical analyses were performed using multivariable logistic regression modelling and Cox proportional hazards models. RESULTS: The overall incidence of UDE was 8.8% (99/1123). Risk factors for UDE included calving during autumn/winter seasons, increased parity and the presence of two or more diseases in the first 50 ± 3 days postpartum. The presence of UDE was associated with a reduced odds of pregnancy after all artificial inseminations up to 150 DIM. LIMITATIONS: The retrospective design of this study led to some inherent limitations with the quality and quantity of data collected. CONCLUSIONS: The findings of this study indicate which risk factors should be monitored in postpartum dairy cows to limit the impact of UDE on future reproductive performance.

Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulation: What We Need to Know and How to Manage for Prolonged Casualty Care.

Coagulopathy can occur in trauma, and it can affect septic patients as a host tries to respond to infection. Sometimes, it can lead to disseminated intravascular coagulopathy (DIC) with a high potential for mortality. New research has delineated risk factors that include neutrophil extracellular traps and endothelial glycocalyx shedding. Managing DIC in septic patients focuses on first treating the underlying cause of sepsis. Further, the International Society on Thrombolysis and Haemostasis (ISTH) has DIC diagnostic criteria. "Sepsis-induced coagulopathy" (SIC) is a new category. Therapy of SIC focuses on treating the underlying infection and the ensuing coagulopathy. Most therapeutic approaches to SIC have focused on anticoagulant therapy. This review will discuss SIC and DIC and how they are relevant to prolonged casualty care (PCC).

Cost-effectiveness and budget impact of heat-stable carbetocin compared to oxytocin and misoprostol for the prevention of postpartum hemorrhage (PPH) in women giving birth in India.

INTRODUCTION: Low- and middle-income countries (LMICs) are committed to achieving the Sustainable Development Goal 3.1 to reduce maternal mortality. The Ministry of Health and Family Welfare of India recommends prophylactic uterotonic administration to every woman following delivery to reduce the risk of postpartum hemorrhage (PPH), as PPH is the leading cause of maternal mortality in LMICs, including India. In 2018, the World Health Organization first recognized heat-stable carbetocin for PPH prevention. Governments are now considering its introduction into their public health systems. METHODS: A decision-tree model was developed from the public healthcare system perspective to compare the value of heat-stable carbetocin versus oxytocin and misoprostol among women giving birth in public sector healthcare facilities in India. The model accounted for differences in PPH risk and costs based on mode of delivery and healthcare setting, as well as provider behavior to mitigate quality concerns of oxytocin. Model outcomes for each prophylactic uterotonic included the number of PPH events, DALYs due to PPH, deaths due to PPH, and direct medical care costs. The budget impact was estimated based on projected uterotonic uptake between 2022-2026. RESULTS: Compared to oxytocin, heat-stable carbetocin avoided 5,468 additional PPH events, 5 deaths, and 244 DALYs per 100,000 births. Projected direct medical costs to the public healthcare system were lowered by US $171,700 (₹12.8 million; exchange rate of ₹74.65 = US$1 from 2 Feb 2022) per 100,000 births. Benefits were even greater when compared to misoprostol (7,032 fewer PPH events, 10 fewer deaths, 470 fewer DALYs, and $230,248 saved per 100,000 births). In the budget impact analysis, India's public health system is projected to save US$11.4 million (₹849 million) over the next five years if the market share for heat-stable carbetocin grows to 19% of prophylactic uterotonics administered. CONCLUSIONS: Heat-stable carbetocin is expected to reduce the number of PPH events and deaths, avoid more DALYs, and reduce costs to the public healthcare system of India. Greater adoption of heat-stable carbetocin for the prevention of PPH could advance India's efforts to achieve its maternal health goals and increase efficiency of its public health spending.

The Glutamatergic System in Treatment-Resistant Depression and Comparative Effectiveness of Ketamine and Esketamine: Role of Inflammation?

The glutamatergic system is the primary excitatory pathway within the CNS and is responsible for cognition, memory, learning, emotion, and mood. Because of its significant importance in widespread nervous system function, it is tightly regulated through multiple mechanisms, such as glutamate recycling, microglial interactions, and inflammatory pathways. Imbalance within the glutamatergic system has been implicated in a wide range of pathological conditions including neurodegenerative conditions, neuromuscular conditions, and mood disorders including depression. Major depressive disorder (MDD) is the most common mood disorder worldwide, has a high prevalence rate, and afflicts approximately 280 million people. While there are numerous treatments for the disease, 30-40% of patients are unresponsive to treatment and deemed treatment resistant; approximately another third experience only partial improvement (World Health Organization, Depression fact sheet [Internet], 2020). Esketamine, the S-enantiomer of ketamine, was approved by the Food and Drug Administration for treatment-resistant depression (TRD) in 2019 and has offered new hope to patients. It is the first treatment targeting the glutamatergic system through a complex mechanism. Numerous studies have implicated imbalance in the glutamatergic system in depression and treatment resistance. Esketamine and ketamine principally work through inhibition of the NMDA receptor, though more recent studies have implicated numerous other mechanisms mediating the antidepressant efficacy of these agents. These mechanisms include increase in brain-derived neurotrophic factor (BDNF), activation of mammalian target of the rapamycin complex (mTORC), and reduction in inflammation. Esketamine and ketamine have been shown to decrease inflammation in numerous ways principally through reducing pro-inflammatory cytokines (e.g., TNF-α, IL-6) (Loix et al., Acta Anaesthesiol Belg 62(1):47-58, 2011; Chen et al., Psychiatry Res 269:207-11, 2018; Kopra et al., J Psychopharmacol 35(8):934-45, 2021). This anti-inflammatory effect has also been shown to be involved in the antidepressive properties of both ketamine and esketamine (Chen et al., Psychiatry Res 269:207-11, 2018; Kopra et al., J Psychopharmacol 35(8):934-45, 2021).

Time and productivity loss associated with immunotherapy infusions for the treatment of melanoma in the United States: a survey of health care professionals and patients.

INTRODUCTION: A new dosing schedule for the oncology immunotherapy pembrolizumab, every 6 weeks (Q6W), has been approved by the U.S. FDA, reducing the frequency of visits to infusion centers. We quantified the time spent by oncologists, nurses, patients, and caregivers per melanoma-related immunotherapy infusion visit to evaluate its potential impact. METHODS: Surveys were self-completed by 100 oncologists, 101 oncology nurses, and 100 patients with melanoma across the U.S. to quantify the time spent per infusion visit with pembrolizumab (Q3W or Q6W), nivolumab (Q2W or Q4W), or nivolumab+ipilimumab (nivolumab in combination: Q3W; nivolumab maintenance: Q2W or Q4W). Time measures included traveling, waiting, consultation, infusion, post-treatment observation, and caregiving. Respondents were also surveyed regarding the impact of the COVID-19 pandemic on infusion treatments. RESULTS: Responses deemed valid were provided by 89 oncologists, 93 nurses, and 100 patients. For each new [returning] patient treated with pembrolizumab, nivolumab or nivolumab+ipilimumab, oncologists reported to spend an average of 90 [64], 87 [60] and 101 [69] minutes per infusion visit (p-value for between-group difference = 0.300 [0.627]). For first [subsequent] treatment cycles, nurses reported spending 160 [145] average minutes per visit for nivolumab+ipilimumab, versus roughly 120 [110] for the single agents (p-value for between-group difference = 0.018 [0.022]). Patients reported to spend an average of 263, 382, and 224 minutes per visit at the center for pembrolizumab (N = 47), nivolumab (n = 34), and nivolumab+ipilimumab (n = 15) respectively (p-value for between-group difference = 0.0002). Patients also reported that their unpaid (N = 20) and paid caregivers (N = 41) spent with them an average of 966 and 333 minutes, respectively, from the day before to the day after the infusion visit. CONCLUSION: Less frequent immunotherapy infusion visits may result in substantial time savings for oncologists, nurses, patients, and caregivers.

Risk Factors Associated with Spinal Cord Ischemia During Aortic Aneurysm Repair.

BACKGROUND: The risk of spinal cord ischemia (SCI) with aortic aneurysm repair can cause significant neurological morbidity. Prevention of SCI is critical. We sought to identify risk factors that predispose to SCI that may guide strategies to mitigate the occurrence of SCI during and following these procedures. METHODS: This study includes all adults who underwent atraumatic, unruptured, thoracic, and suprarenal aortic aneurysm repairs (endovascular or open) at our institution over 11 years (2010-2020). Our database included patient demographics, aneurysm anatomic features, and operative characteristics and an extreme gradient boost (XGB) machine method was used to develop a predictive model for SCI. The model was trained on an 80% randomly stratified cohort of the data and tested on the remaining 20% testing cohort. Shapley values were used to determine the most important predictive factors of SCI and decision trees were used to identify risk factor threshold values and highest risk factor combinations. RESULTS: Information was collected for 174 adult patients undergoing thoracic and suprarenal aortic repair from 2010 to 2020. Fifty eight percent of the patients were male. Ninety seven (55.7%) patients had open aortic repair and 87 (44.3%) had endovascular repair. Twenty seven (15%) of all patients had major complications and were considered to have SCI. The XGB model converged over the training cohort with a testing cohort accuracy of 0.841 [Sensitivity = 75%, Specificity = 68%] and area under the curve of receiver operating characteristic of 0.774. The XGB model identified older age (> 65 years), history of neurologic disease, hyperlipidemia, diabetes, coronary artery disease, heart failure, poor renal function, < 6 months since last aortic repair, chronic anticoagulant use, preoperational anemia (Hemoglobin < 9), thrombocytopenia (platelet < 90,000), coagulopathy (prothrombin time > 15s and activated partial thromboplastin time > 40s), hypotension (mean arterial pressure < 70 mm Hg), longer operations (> 100 min), aneurysms longer than 5 cm, and anatomic location of aneurysm caudal to T-11 as risk factors for SCI in all types of aortic repair. Diabetic and heart failure patients undergoing longer operations (> 100 min) with thrombocytopenia or aneurysms longer than 5 cm were at the highest risk. CONCLUSIONS: The XGB model accurately identified risk factors of SCI with aortic aneurysm repair that may guide patient selection, timing of surgery, and strategies to minimize the risk of SCI.

Lumbar Degenerative Disease and Muscle Morphology Before and After Lower Limb Loss in Four Military Patients.

INTRODUCTION: Low back pain (LBP) is highly prevalent after lower limb amputation (LLA). Reports describing longitudinal changes in spine health before and after amputation are rare. This study describes lumbar spine pathology, muscle morphology, and the continuum of care for LBP before and after LLA. MATERIALS AND METHODS: We queried electronic medical records of patients who sought care for LBP before and after unilateral LLA between January 2002 and April 2020 and who had documented lumbar imaging pre- and post-LLA. Patient demographics, muscle morphology, spinal pathology, premorbid and comorbid conditions, self-reported pain, and treatment interventions were assessed. RESULTS: Four patients with LBP and imaging before and after LLA were identified. Intervertebral disc degeneration progressed after amputation in three patients, whereas facet arthrosis progressed in both female patients. The fat content of lumbar musculature generally increased after amputation. Conservative management of LBP before and after amputation was standard, with progression to steroidal injections. CONCLUSIONS: Lumbar spine health may degrade after amputation. Here, lumbar muscle size did not change after LLA, yet the fat content increased in combination with increases in facet and intervertebral disc degeneration.

The effect of modulation of gut microbiome profile on radiation-induced carcinogenesis and survival.

Non-lethal doses of ionizing radiation (IR) delivered to humans because of terrorist events, nuclear accidents or radiotherapy can result in carcinogenesis. Means of protecting against carcinogenesis are lacking. We questioned the role of the gut microbiome in IR-induced carcinogenesis. The gut microbiome was modulated by administering broad spectrum antibiotics (Ab) in the drinking water. Mice were given Ab 3 weeks before and 3 weeks after 3 Gy total body irradiation (TBI) or for 6 weeks one month after TBI. Three weeks of Ab treatment resulted in a 98% reduction in total 16S rRNA counts for 4 out of 6 of the phylum groups detected. However, 3 more weeks of Ab treatment (6 weeks total) saw an expansion in the phylum groups Proteobacteria and Actinobacteria. The Ab treatment altered the bacteria diversity in the gut, and shortened the lifespan when Ab were administered before and after TBI. Mortality studies indicated that the adverse Ab lifespan effects were due to a decrease in the time in which solid tumors started to appear and not to any changes in hematopoietic or benign tumors. In contrast, when Ab were administered one month after TBI, lifespan was unchanged compared to the control TBI group. Use of broad-spectrum antibiotics to simulate the germ-free condition did not afford an advantage on carcinogenesis or lifespan.

A Quantitative and Qualitative Literature Analysis of the Orthopedic Surgeons' Experience: Reflecting on 20 Years in the Global War on Terror.

INTRODUCTION: After over 20 years of war in the Middle East, orthopedic injuries have been among the most prevalent combat-related injuries, accounting for 14% of all surgical procedures at Role 2/3 (R2/R3) facilities according to the DoD Trauma Registry. To further delineate the role of the deployed orthopedic surgeon on the modern battlefield, a retrospective review was performed highlighting both quantitative and qualitative analysis factors associated with orthopedic surgical care during the war in the Middle East. METHODS: A retrospective review was conducted of orthopedic surgeons in the Middle East from 2001 to 2021. A comprehensive literature search was conducted using the PubMed and Embase databases using a two-reviewer strategy. Articles were compiled and reviewed using Covidence. Inclusion criteria included journal articles focusing on orthopedic injuries sustained during the Global War on Terror (GWoT) in an adult U.S. Military population. In the event of a conflict, a third author would determine the relevance of the article. For the remaining articles, a full-text review was conducted to extract relevant predetermined quantitative data, and the Delphi consensus method was then utilized to highlight relevant qualitative themes. RESULTS: The initial search yielded 1,226 potentially relevant articles. In all, 40 studies ultimately met the eligibility criteria. With the consultation of previously deployed orthopedic surgeons at the Walter Reed National Military Medical Center, a retrospective thematic analysis of the 40 studies revealed five themes encompassing the orthopedic surgeons experience throughout GWoT. These themes include unique mechanisms of orthopedic injury compared to previous war injuries due to novel weaponry, differences in interventions depending on R2 versus R3 locations, differences in injuries from those seen in civilian settings, the maintained emphasis on humanitarian aspect of an orthopedic surgeon's mission, and lastly relation of pre-deployment training to perceived deployed success of the orthopedic surgeons. From this extensive review, we found that explosive mechanisms of injury were greatly increased when compared to previous conflicts and were the etiology for the majority of orthopedic injuries sustained. With the increase of complex explosive injuries in the setting of improved body armor and overall survival, R2/3 facilities showed an increased demand for orthopedic intervention including debridement, amputations, and external fixation. Combat injuries sustained during the GWoT differ in the complications, management, and complexity when compared to civilian trauma. "Humanitarian" cases made up a significant number of operative cases for the deployed orthopedic surgeon. Lastly, heterogeneous training opportunities were available prior to deployment (fellowship, combat extremity surgical courses, and dedicated pre-deployment training), and the most commonly identified useful training was learning additional soft-tissue coverage techniques. CONCLUSION: These major themes indicate an emphasis on pre-deployment training and the strategic positioning of orthopedic surgeons to reflect the changing landscape of musculoskeletal trauma care. Moving forward, these authors recommend analyzing the comfort and perceived capability of orthopedic surgeons in these unique military environments to best prepare for a changing operational format and the possibility of future peer-peer conflicts that will likely lead to a lack of medical evacuation and prolonged field care.

Azospirillum brasilense improves rice growth under salt stress by regulating the expression of key genes involved in salt stress response, abscisic acid signaling, and nutrient transport, among others.

Major food crops, such as rice and maize, display severe yield losses (30-50%) under salt stress. Furthermore, problems associated with soil salinity are anticipated to worsen due to climate change. Therefore, it is necessary to implement sustainable agricultural strategies, such as exploiting beneficial plant-microbe associations, for increased crop yields. Plants can develop associations with beneficial microbes, including arbuscular mycorrhiza and plant growth-promoting bacteria (PGPB). PGPB improve plant growth via multiple mechanisms, including protection against biotic and abiotic stresses. Azospirillum brasilense, one of the most studied PGPB, can mitigate salt stress in different crops. However, little is known about the molecular mechanisms by which A. brasilense mitigates salt stress. This study shows that total and root plant mass is improved in A. brasilense-inoculated rice plants compared to the uninoculated plants grown under high salt concentrations (100 mM and 200 mM NaCl). We observed this growth improvement at seven- and fourteen days post-treatment (dpt). Next, we used transcriptomic approaches and identified differentially expressed genes (DEGs) in rice roots when exposed to three treatments: 1) A. brasilense, 2) salt (200 mM NaCl), and 3) A. brasilense and salt (200 mM NaCl), at seven dpt. We identified 786 DEGs in the A. brasilense-treated plants, 4061 DEGs in the salt-stressed plants, and 1387 DEGs in the salt-stressed A. brasilense-treated plants. In the A. brasilense-treated plants, we identified DEGs involved in defense, hormone, and nutrient transport, among others. In the salt-stressed plants, we identified DEGs involved in abscisic acid and jasmonic acid signaling, antioxidant enzymes, sodium and potassium transport, and calcium signaling, among others. In the salt-stressed A. brasilense-treated plants, we identified some genes involved in salt stress response and tolerance (e.g., abscisic acid and jasmonic acid signaling, antioxidant enzymes, calcium signaling), and sodium and potassium transport differentially expressed, among others. We also identified some A. brasilense-specific plant DEGs, such as nitrate transporters and defense genes. Furthermore, our results suggest genes involved in auxin and ethylene signaling are likely to play an important role during these interactions. Overall, our transcriptomic data indicate that A. brasilense improves rice growth under salt stress by regulating the expression of key genes involved in defense and stress response, abscisic acid and jasmonic acid signaling, and ion and nutrient transport, among others. Our findings will provide essential insights into salt stress mitigation in rice by A. brasilense.

When Science Becomes Embroiled in Conflict: Recognizing the Public's Need for Debate while Combating Conspiracies and Misinformation.

Most democracies seek input from scientists to inform policies. This can put scientists in a position of intense scrutiny. Here we focus on situations in which scientific evidence conflicts with people's worldviews, preferences, or vested interests. These conflicts frequently play out through systematic dissemination of disinformation or the spreading of conspiracy theories, which may undermine the public's trust in the work of scientists, muddy the waters of what constitutes truth, and may prevent policy from being informed by the best available evidence. However, there are also instances in which public opposition arises from legitimate value judgments and lived experiences. In this article, we analyze the differences between politically-motivated science denial on the one hand, and justifiable public opposition on the other. We conclude with a set of recommendations on tackling misinformation and understanding the public's lived experiences to preserve legitimate democratic debate of policy.

[Validity of an instrument for screening households at risk of food insecurity in different strata of the Brazilian population]. / Validade do instrumento para triagem de domicílios em risco de insegurança alimentar em diversos estratos da população brasileira.

The absence of risk screening tools for food insecurity compromises the ability to assess, monitor, and provide immediate assistance to those in hunger, especially during emergencies such as the COVID-19 crisis. Hence, this study sought to test the validity of an instrument for Screening Households at Risk of Food Insecurity (TRIA) in different strata of the Brazilian population TRIA uses questions 2 and 4 of the Brazilian Food Insecurity Scale (EBIA), originally validated using data from the Brazilian National Survey of Demography and Health of Children and Women (PNDS 2006). In this study, using data from the Brazilian National Household Sample Survey (PNAD 2013), its reproducibility was tested by repeating the original combinatorial procedures, examining whether the parameters of sensitivity, specificity, accuracy, and positive predictive values (PPV) and negative values (NPV) would result in the same arrangement of questions. Moreover, convergent validity was analyzed by comparing the strength of association between food insecurity and dietary variables using two binomial regression models (TRIA x EBIA). Results indicated that the combination of questions 2 and 4 performed best among the population strata studied, and presented optimal convergent validity. PPV and NPV adjusted for food insecurity prevalence in states ranged from 42.8% (Santa Catarina) to 87.6% (Amazonas) and 95.8% (Amazonas) to 99.5% (Santa Catarina), respectively. In conclusion, besides being reproducible, TRIA presented excellent validity parameters, especially among vulnerable groups. It can thus be used in care practice and as an instrument of food and nutritional surveillance in Brazil.

A ausência de instrumentos de triagem de risco para insegurança alimentar compromete a capacidade de avaliar, monitorar e ofertar assistência imediata a pessoas em situação de fome, especialmente durante emergências, como a crise da COVID-19. Assim, o objetivo deste estudo foi testar a validade do instrumento de Triagem para Risco de Insegurança Alimentar (TRIA), em diversos estratos da população brasileira. A TRIA é composta pelas questões 2 e 4 da Escala Brasileira de Insegurança Alimentar (EBIA), validada, originalmente, a partir de dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006). Neste estudo, utilizando dados da Pesquisa Nacional por Amostra de Domicílios (PNAD 2013), testou-se sua reprodutibilidade por meio da repetição dos procedimentos combinatórios originais, examinando se os parâmetros de sensibilidade, especificidade, acurácia e valores preditivos positivo (VPP) e negativo (VPN) resultariam no mesmo arranjo de questões. Ainda, analisou-se a validade convergente comparando a força de associação entre insegurança alimentar e variáveis alimentares por meio de dois modelos de regressão binomial (TRIA x EBIA). Os resultados indicaram que a combinação das questões 2 e 4 apresentou melhor desempenho entre os estratos populacionais estudados, além de ótima validade convergente. O VPP e VPN ajustado pela prevalência de insegurança alimentar nos estados variou de 42,8% (Santa Catarina) a 87,6% (Amazonas) e 95,8% (Amazonas) a 99,5% (Santa Catarina), respectivamente. Em conclusão, além de ser reprodutível, a TRIA apresentou excelentes parâmetros de validade, sobretudo em grupos vulnerabilizados. Assim, seu uso pode ser recomendado na prática assistencial e como instrumento de vigilância alimentar e nutricional no Brasil.

La ausencia de instrumentos de triaje de riesgo para la inseguridad alimentaria compromete la capacidad de evaluar, monitorear y brindar asistencia inmediata a las personas en situación de hambre, especialmente durante emergencias como la crisis de la COVID-19. Por lo tanto, el objetivo de este estudio fue probar la validez del instrumento de Triaje para Riesgo de Inseguridad Alimentaria (TRIA) en diferentes estratos de la población brasileña. El TRIA consta de las preguntas 2 y 4 de la Escala Brasileña de Inseguridad Alimentaria (EBIA), originalmente validada con base en datos de la Encuesta Nacional de Demografía y Salud de la Mujer y el Niño (PNDS 2006). En este estudio, utilizando datos de la Encuesta Nacional por Muestra de Domicilios (PNAD 2013), se probó su reproducibilidad repitiendo los procedimientos combinatorios originales, examinando si los parámetros de sensibilidad, especificidad, exactitud y valores predictivos positivos (VPP) y negativo (VPN) resultarían en el mismo arreglo de preguntas. Además, se analizó la validez convergente comparando la fuerza de asociación entre la inseguridad alimentaria y las variables alimentarias por medio de dos modelos de regresión binomial (TRIA x EBIA). Los resultados indicaron que la combinación de las preguntas 2 y 4 presentó el mejor desempeño entre los estratos poblacionales estudiados, además de excelente validez convergente. El VPP y el VPN ajustado por la prevalencia de inseguridad alimentaria en los estados osciló entre el 42,8% (Santa Catarina) y el 87,6% (Amazonas) y entre el 95,8% (Amazonas) y el 99,5% (Santa Catarina), respectivamente. En conclusión, además de ser reproducible, el TRIA presentó excelentes parámetros de validez, especialmente en grupos en situación de vulnerabilidad. Por lo tanto, se puede recomendar su uso en la práctica asistencial y como instrumento para la vigilancia alimentaria y nutricional en Brasil.

Adjunctive dopaminergic enhancement of esketamine in treatment-resistant depression.

Esketamine is a novel treatment for treatment resistant depression (TRD) and was approved by the FDA in early 2019. It antagonizes the NMDA receptor providing rapid improvement in symptoms with a complex mechanism of action primarily mediated through glutamatergic activation. Significant barriers exist to widespread use of esketamine including durability of response, particularly in the maintenance phase. Since it must be administered in combination with an oral antidepressant, investigating appropriate treatments to be given concomitantly may further improve outcomes and response duration. Specifically, due to dysfunction in dopaminergic pathways in many patients with MDD and TRD, addition of a prodopaminergic agent, such as bupropion, may provide additional benefit and durability of response. Historically, the addition of a dopaminergic agent to traditional treatment (e.g., SSRI, SNRI) has been shown to improve response in TRD. While we have anecdotal evidence to support adjunctive dopaminergic enhancement of esketamine response, robust data are limited. There are case reports that exhibit efficacy with the use of a MAO-I in combination with ketamine supporting at least in part a dopaminergic component. Additionally, there is mechanistic rationale for the use of dopaminergic agents with a NMDA antagonist. This includes co-localization of NMDA and dopamine receptors as well as increased glutamatergic signaling due to dopamine-induced phosphorylation of AMPAR. Recently, AXS-05, an oral combination of dextromethorphan and bupropion, has shown promise in both MDD and TRD clinical trials highlighting the potential validity of this mechanism. This paper describes how dopaminergic enhancement may increase efficacy and durability of response with esketamine, encouraging further research into this treatment option.