Saint Louis University

Conservation measures require accurate estimates of density and abundance and population trend assessments. The bonobo (Panpaniscus) is considered Endangered in the IUCN Red List. This classification assumes that available population data are representative. However, with only 30% of the bonobo’s historic geographical range surveyed, reliable information is needed to assess the species' population status. Here, we use information from 13 surveys conducted between 2002 and 2018 in an area of 42,000 km², representing ~27% of bonobo-suitable habitat: Salonga National Park and its corridor, Democratic Republic of the Congo (DRC). Using 8310 km of reconnaissance and transect walks and 27,045 days of camera trapping, we: (1) provide updated estimates of bonobo population density and distribution (42,000 km²; ~5,000 km² of which, to the best of our knowledge, have not been surveyed before by scientists), (2) assess population trends (15,758 km²; 2002–2008 vs 2012–2018), (3) compare estimates obtained with different methods, and (4) assess the factors driving bonobo density and distribution. Although we detected a non-significant population decline, our study suggests that Salonga is a bonobo stronghold, with a population ranging between 8244 and 18,308 mature individuals (density: 0.31 individuals/km²). Standing crop nest counts returned non-significantly lower density estimates than camera trap distance sampling. Nest count-estimates were higher in areas with Marantaceae understorey and those farther away from rivers, while camera trap-estimates were higher in areas with lower human presence. Regardless of the method, bonobos were rarer in proximity to villages. They occurred more often in areas of dense forest cover and in proximity to ranger posts. Our results point towards a declining bonobo population in Salonga, but do not provide sufficient evidence to confirm this statistically. Consequently, the continued monitoring of the bonobo population and preservation of the integrity of Salonga, considering its biological and cultural heritage, will be crucial in the preservation of this stronghold of wild bonobos.

Study reveals student anxiety negatively correlates with perceived instructor support in biology classes, changing over the semester. Findings at weeks 4 and 14 show variability, suggesting targeted instructor development could aid high-anxiety students.

Aims Clarify the concept of spiritual competence in the context of nursing through evidence‐based extraction of attributes, antecedents and consequences. Design Concept analysis. Methods Rodgers' evolutionary method of concept analysis guided this analysis, and we followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews. Results An analysis of 45 studies clarified the concept of spiritual competence in the context of nursing. Spiritual competence in nursing is a dynamic process that, once initiated by nurses' spiritual awareness, promotes their spiritual well‐being, their spiritual knowledge and skills and their sense of spiritual‐care self‐efficacy. Conclusion A comprehensive understanding and clear conceptual definition of the concept of spiritual competence in nursing will enable researchers to overcome barriers and foster nurses' development of spiritual competence to provide spiritual care in nursing. Implications for the Profession and Patient Care The clarified concept of spiritual competence in nursing can help to shape education and clinical‐training programs for nurses in a way that supports their ability to provide spiritual care and promote patient well‐being and positive health outcomes. Patient or Public Contribution No patient or public contribution was essential to the conduct of this research.

Background Patients with congenital heart disease (CHD) are more likely to experience ischemic and hemorrhagic stroke due to factors such as arrhythmias, residual shunts and related cardiovascular complications. However, guidelines for identifying CHD patients at the highest risk of stroke remain unclear. In this study, we aimed to evaluate the risk of developing stroke in patients with CHD. Methods A systematic literature search was performed on PubMed, Scopus, Cochrane, and Embase databases to retrieve studies that evaluated stroke risk in patients with CHD. Random effects model was used to pool the hazard ratios (HR) with 95% confidence intervals (CI). Subgroup analysis was conducted on age, type of stroke, type of study and region. Publication bias was assessed by Egger’s regression test. Statistical significance was set at p < 0.05. All the analysis was performed using R studio V4.3.1. Results Eleven studies (5,490,412 participants) were included in this systematic review and meta-analysis. Patients with CHD were at a higher risk of stroke [Pooled HR: 3.25; 95% CI: 2.25, 4.68; p < 0.01; I²: 100%] than the control group. In subgroup analysis, patients with CHD were at a higher risk of ischemic stroke [Pooled HR: 4.45; 95% CI: 2.24, 8.85; p < 0.01; I²: 100%] and hemorrhagic stroke [Pooled HR: 4.70; 95% CI: 1.70, 12.96; p < 0.01; I²: 99%] than the control group. Conclusion Our meta-analysis indicates a significantly increased stroke risk in patients with CHD. Subgroup analyses showed higher stroke risk in European regions compared to Asia and USA, and among adults compared to pediatric populations. Future studies should focus on addressing regional and data limitations to better inform clinical strategies for managing stroke risk in CHD patients. Graphical Abstract

Background Suicide is a global public health concern that affects more than 700,000 people globally every year. Seasonal variation in suicide rates is a phenomenon that has been well-documented, but recent data on the seasonality of suicide within specific age groups and sex in the United States remains less well understood. Methods Publicly available data on monthly suicides was obtained from the Underlying Cause of Death database, CDC WONDER, from 2015–2020. The incidence of summer suicides, from June, July and August, for two groups, 15–24 and ages 25 + , was calculated and a two-sided test was performed. Seasonal Decomposition analysis was performed and time series created from 2015–2020 for every age group then converted into Trend, Seasonality, and Residual respectively. Results For Americans ages 15–24, the highest spike in suicides was in autumn, September–October, with a trough in June. This is the only age group in which this occurred, differing from previous understanding of the seasonality of suicide in the literature. With all other age groups (25–34, 35–44, 45–54, 55–64, 65–74, 75 +) there was a consistent pattern of a peak in late spring/early summer, a small peak in fall, and a trough in late winter. Conclusions There is a seasonal variation in suicide deaths in the United States with the youngest group, ages 15–24, presenting a different pattern compared to other ages. There were no significant differences in suicide seasonality by sex.

Childhood maltreatment is associated with significant psychological distress and coping-related maladaptive behaviors that can extend into adulthood. Non-suicidal self-injury is one form of maladaptive coping characterized by engaging in the commission of self-harm. This study explored if coping with childhood maltreatment may manifest in different forms, including behavioral omission in which an individual harms themselves through a lack of self-care. We proposed the novel construct of self-deprivation as an omissive self-harming behavior. Self-deprivation is defined as engaging in low levels of self-care motivated by an intent to harm oneself. One hundred twenty adults (72% women; M age = 31.5) with reported childhood maltreatment were recruited from an online research platform using voluntary response sampling for our cross-sectional, survey-based study. Participants responded to questions about their trauma history, self-care behaviors, and the motivations underlying their decisions about such behaviors. We found a significant, negative relationship between history of childhood maltreatment and frequency of self-care (r(118) = -.210, p = .02). We then used PROCESS macro to examine the meditating role of an motivation to harm oneself. Consistent with the construct of self-deprivation, this association was significantly mediated by an intrapersonal motivation to harm oneself (ab = -.0692, CI [-.1605, -.0021]). These findings provided preliminary support for the novel construct of self-deprivation. Results have implications for both research and clinical practice, including evidence for omissive self-harming behaviors that upon future research may be relevant to the overall framework of self-harm. Further study with different methodologies and populations are needed to continue the exploration and boundaries of this construct.

Objectives To gather perspectives on childhood vaccination and vaccine hesitancy, the Saint Louis County Department of Public Health (DPH) surveyed parents seeking nonmedical exemptions, conducted focus groups of school nurses, and interviewed pediatricians. Methods We distributed exemption forms and voluntary questionnaires to parents in St Louis County who were seeking nonmedical exemptions for their school-aged children at any DPH clinic from August 2019 through December 2022. We conducted and recorded four 75- to 90-minute focus groups of 11 school nurses in groups of 2 or 3 nurses in September 2022. We conducted and recorded interviews of 8 pediatricians in March 2023. We calculated descriptive statistics, transcribed focus group discussions and interviews, and performed qualitative coding. Results We collected 1871 exemption forms. The median age of children (n = 1854) was 6 years. Of the 10 vaccines included in the exemption list, the percentage of exclusions ranged from 91.2% for meningococcal conjugate to 88.7% for hepatitis A. We identified 4 themes in the focus groups: recent changes in vaccine compliance, hesitancy and barriers, services addressing hesitancy and barriers, and future requests for DPH. Analysis of pediatrician interviews revealed themes relating to vaccine information, community efforts, and physician decision-making. Conclusions This study highlights the need for a multidisciplinary approach to vaccine hesitancy in St Louis County. Future interventions need to focus on beliefs and behavioral change related to vaccines and not just the economics and accessibility of vaccines.

TAR DNA binding protein 43 (TDP-43) is an RNA binding protein that accumulates as aggregates in the central nervous systems of some patients with neurodegenerative diseases. However, TDP-43 aggregation is also a sensitive and specific pathologic feature found in a family of degenerative muscle diseases termed inclusion body myopathy. TDP-43 aggregates from amyotrophic lateral sclerosis (ALS) and frontotemporal dementia brain lysates may serve as self-templating aggregate seeds in vitro and in vivo, supporting a prion-like spread from cell to cell. Whether a similar process occurs in patient muscle is not clear. We developed a mouse model of inducible, muscle-specific cytoplasmic localized TDP-43. These mice develop muscle weakness with robust accumulation of insoluble and phosphorylated sarcoplasmic TDP-43, leading to eosinophilic inclusions, altered proteostasis, and changes in TDP-43–related RNA processing that resolve with the removal of doxycycline. Skeletal muscle lysates from these mice also have seeding-competent TDP-43, as determined by a FRET-based biosensor, that persists for weeks upon resolution of TDP-43 aggregate pathology. Human muscle biopsies with TDP-43 pathology also contain TDP-43 aggregate seeds. Using lysates from muscle biopsies of patients with sporadic inclusion body myositis (IBM), immune-mediated necrotizing myopathy (IMNM), and ALS, we found that TDP-43 seeding capacity was specific to IBM. TDP-43 seeding capacity anticorrelated with TDP-43 aggregate and vacuole abundance. These data support that TDP-43 aggregate seeds are present in IBM skeletal muscle and represent a unique TDP-43 pathogenic species not previously appreciated in human muscle disease.

We previously reported N -hydroxypyridinedione (HPD) compounds with mid-nanomolar efficacy and selectivity indexes around 300 against hepatitis B virus (HBV) replication. However, they lack pharmacological evaluation. Here, we report in vitro anti-HBV efficacy, cytotoxicity, and pharmacological characterization of 29 novel HPDs within seven subgroups. The best two compounds had EC 50 s of 61 and 190 nM and selectivity indexes of 526 and 1,071. Compounds with one halogen on the major R group were most effective and compounds with large ether R groups were most cytotoxic. Compounds were not cytotoxic in primary human hepatocytes. All compounds were freely soluble in pHs reflecting plasma (7.4) and the gastrointestinal tract (5 and 6.5). Almost all highly soluble compounds were passively permeable at pH 5.0 and 7.4. Only 2 of 11 compounds tested were likely to be effluxed by p-glycoprotein. The most potent HPDs inhibited HBV replication over human ribonuclease H1 activity by 10-fold. Four of 19 compounds inhibited CYP2D6 >50%, but their CYP2D6 IC 50 s were >8× higher than their anti-HBV EC 50 . No compound substantially inhibited CYP3A4. Thirteen of 15 compounds had human microsomal half-lives >30 min with medium to low rates of intrinsic clearance. Eleven of 12 compounds bound plasma proteins by ≥80%; however, effects against HBV replication for only one would likely be physiologically relevant. These results identify two lead candidate HPDs with pharmacological characteristics resembling commercially available drugs that are suitable for in vivo pharmacological and efficacy studies.

Background The congruence or discordance between actual and perceived balance ability has been proposed to be linked to functional outcomes such as falls. However, gaps remain in our ability to quantify discordance, and its relationship to relevant outcomes. Objective To investigate a novel quantification of concordance/discordance between balance performance and perception and determine the relationship to falls among people with Parkinson’s disease (PwPD). Methods Data from 244 PwPD were aggregated from 5 previously conducted studies. Variables extracted included age, sex, Activities-Specific Balance Confidence scale (ABC; perceived balance), Timed Up and Go (TUG; balance performance), Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) part III scores, and retrospective falls (6- or 12-month). Data validation between studies was established. Discordance was quantified as the difference between an individual’s predicted ABC, based upon their TUG score, to their reported ABC. Results Two methods for calculating discordance were tested: simple linear regression and segmented regression. As there were no differences between the bootstrap distributions of both approaches ( P = .520), simple linear regression was utilized for the subsequent logistic regression model. Discordance was the only statistically significant predictor of fall status (OR = 0.98, P = .003), after controlling for age, MDS-UPDRS part III, sex, and TUG. The inclusion of discordance in the logistic regression model boosted the predictive accuracy by 58%. Conclusions Discordance between actual and perceived balance was uniquely related to retrospective fall history among PwPD. Clinicians and researchers should consider discordance between actual and perceived balance as a potentially modifiable target to minimize falls.

Trisomy 18 (T18) is the second‐most common autosomal trisomy and includes multiple anomalies, growth restriction, and a severely shortened life span, often lasting only hours or days. Côté‐Arsenault and Denney‐Koelsch extended Reva Rubin's work, describing the psychosocial stages of pregnancy by describing the stages and developmental tasks for a pregnancy altered by a life‐limiting fetal condition such as T18. When a diagnosis of T18 is made prenatally, the pregnancy changes dramatically, although it remains a psychosocial developmental process. The extended stages of pregnancy with T18 or another life‐limiting fetal condition are: Pre‐Diagnosis, Learning the Diagnosis, Living With the Diagnosis, Birth and Death, and Post Death. As they navigate these stages, parents must also address 7 developmental tasks of pregnancy, which are (1) Navigating Relationships, (2) Comprehending Implications of the Condition, (3) Revising Goals of Pregnancy, (4) Making the Most of Time With Baby, (5) Preparing for Birth and Inevitable Death, (6) Advocating for Baby With Integrity, and (7) Adjusting to Life in Absence of Baby. Knowledgeable health care providers can do much more than support parents through grief and facilitate discussions about birth planning. This case report highlights the importance of a knowledgeable provider who can help parents navigate the stages and tasks of pregnancy, empowering them to make choices consistent with their values so they have no regrets.

The dimensions of phylogenetic research have expanded to encompass the study of large‐scale populations at the microevolutionary level and comparisons between different species or taxonomic units at the macroevolutionary level. Traditional phylogenetic tools often struggle to handle the diverse and complex data required for these different evolutionary scales. In response to this challenge, we introduce PhyloForge, a robust tool designed to seamlessly integrate the demands of both micro‐ and macroevolution, comprehensively utilising diverse phylogenomic signals, such as genes, SNPs, and structural variations, as well as mitochondrial and chloroplast genomes. PhyloForge's innovation lies in its capability to seamlessly integrate multiple phylogenomic signals, enabling the unified analysis of multidimensional genomic data. This unique feature empowers researchers to gain a more comprehensive understanding of diverse aspects of biological evolution. PhyloForge not only provides highly customisable analysis tools for experienced researchers but also features an intuitively designed interface, facilitating effortless phylogenetic analysis for beginners. Extensive testing across various domains, including animals, plants and fungi, attests to its broad applicability in the field of phylogenetics. In summary, PhyloForge has significant potential in the era of large‐scale genomics, offering a new perspective and toolset for a deeper understanding of the evolution of life. PhyloForge codes could be found in GitHub ( https://github.com/wangyayaya/PhyloForge/ ), and the program could be installed in Conda ( https://anaconda.org/wangxiaobei/phyloforge ).

BACKGROUND Implementation of a successful night curriculum has been a historical barrier to education during night rotations. Residents are tasked with teaching students and peers at night, often with little educational material to support this. To address the need for engaging night curriculum for pediatric residents, we aimed to (1) develop and implement a night curriculum with an emphasis on residents as teachers (RaTs) and (2) explore residents’ experience with the RaT curriculum through a secondary qualitative analysis of reflections. METHODS After a needs assessment, we developed and implemented a night curriculum consisting of both facilitated and independent learning activities. Each resident was expected to complete 3 out of the offered 5 to 7 learning activities during their month-long night rotation. One independent activity featured RaT topics, including clinical teaching, mentoring, or hidden curriculum. Participation was tracked via reflection submissions, which were inductively coded using Dedoose. RESULTS A total of 90% (180/199) of resident rotations completed new curriculum requirements, with 45% (90/199) completing more than the required 3 activities. A total of 76% (151/199) chose to participate in the RaT activity as part of their night educational requirements. A total of 52 reflection responses were collected, 38 individual and 14 team responses. Responses highlighted themes including growing as educators, fostering interprofessional relationships, and developing careers. CONCLUSIONS High participation in the novel curriculum reveals the potential of virtual RaT activities to improve night education for residents. Participant reflections suggest high engagement in RaT and emphasize the andragogical value of key topics.