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\"Stories to delight before you say night-night! A collection of five beautifully illustrated animal adventures, perfect for sharing with little ones at bedtime\"-- Back cover.

This article explores the current landscape of clinical education in obstetrics and gynecology for medical students, residents, and fellows who identify as male. Academic, clinical instruction should be inclusive for the betterment of the training experience for all, but most importantly, for the betterment of women’s health.

\"What is it to pursue a goal, to strive for an ideal, to follow a dream? These are the questions explored by The Balvenie in this unique collection compiled by award-winning novelist Alex Preston. The stories - from some of the brightest and most exciting voices writing today - tell of determination, endeavour and perseverance against the odds. They range across wildly different contexts and cultures, from the epic to the intimate, in fiction and non-fiction, illustrating and illuminating the outer limits of human character and achievement.\"--Publisher description.

The DNA damage response is essential to safeguard genome integrity. Although the contribution of chromatin in DNA repair has been investigated 1 , 2 , the contribution of chromosome folding to these processes remains unclear 3 . Here we report that, after the production of double-stranded breaks (DSBs) in mammalian cells, ATM drives the formation of a new chromatin compartment (D compartment) through the clustering of damaged topologically associating domains, decorated with γH2AX and 53BP1. This compartment forms by a mechanism that is consistent with polymer–polymer phase separation rather than liquid–liquid phase separation. The D compartment arises mostly in G1 phase, is independent of cohesin and is enhanced after pharmacological inhibition of DNA-dependent protein kinase (DNA-PK) or R-loop accumulation. Importantly, R-loop-enriched DNA-damage-responsive genes physically localize to the D compartment, and this contributes to their optimal activation, providing a function for DSB clustering in the DNA damage response. However, DSB-induced chromosome reorganization comes at the expense of an increased rate of translocations, also observed in cancer genomes. Overall, we characterize how DSB-induced compartmentalization orchestrates the DNA damage response and highlight the critical impact of chromosome architecture in genomic instability. After the production of double-stranded breaks in mammalian cells, ATM drives the formation of the D compartment, which regulates DNA damage-responsive genes, through the clustering of damaged topologically associating domains, with a mechanism that is consistent with polymer–polymer phase separation.

Eutrophication represents a major threat to freshwater systems and climate change is expected to drive further increases in freshwater primary productivity. However, long‐term in situ data is available for very few lakes and makes identifying trends and drivers of eutrophication challenging. Using remote sensing data, we conducted a retrospective analysis of long‐term trends in trophic status among lakes greater than 10 ha across the Intermountain West, a region with understudied water quality trends and limited long‐term data sets. We found that most lakes (55%) were not exhibiting shifts in trophic status from 1984 to 2019. Our results also show that increases in eutrophication were rare (3% of lakes) during this period, and that lakes becoming increasingly oligotrophic were more common (17% of lakes). Lakes that were not trending occupied a wide range of lake and landscape characteristics, whereas lakes that were becoming more oligotrophic tended to have larger residence times and were located in catchments with greater clay content and more development. Our results highlight that while there are well‐established narratives that climate change can lead to more eutrophication of lakes, this is not broadly observed in our data set, where we found more lakes in the Intermountain West becoming more oligotrophic than lakes becoming eutrophic. Plain Language Summary Lakes are often classified by their productivity. Low productivity lakes are generally deep with low nutrient levels and low amounts of algae. Whereas lakes with high levels of productivity support more plant growth and have higher amounts of algae. The accumulation of nutrients in freshwater systems often results in increases in productivity and can lead to the development of algal blooms. Algal blooms are a major concern due to their threat to ecosystem health, recreation, and drinking water sources. Yet the lack of long‐term field data across large scales has resulted in a limited understanding of (a) what are the long‐term trends in lake productivity and how does this relate to trends in algal blooms, and (b) what factors are driving productivity trends and the development of algal blooms across regions. Therefore, there is a pressing need to effectively monitor and understand these trends in order to inform management actions that address their frequency and intensity. Here, we use data obtained from satellite imagery from 1984 to 2019 to document lake productivity trends in 1,169 lakes across the Intermountain West. We show that substantial increases in productivity over this time period were rare, and that the majority of lakes have not undergone widespread change. Key Points Remote sensing imagery captures long‐term trends in lake productivity across the Intermountain West The majority of lakes observed in this data set were not exhibiting shifts in trophic status from 1984 to 2019 The incorporation of fine‐scale lake climate data from new deep learning data sets results in substantial improvement to model accuracy

Many health care organizations around the world have implemented health information technologies (ITs) to enhance health service efficiency, effectiveness, and safety. Studies have demonstrated that promising outcomes of health IT initiatives can be obtained when patients and family members participate and engage in the adoption, use, and evaluation of these technologies. Despite knowing this, there is a lack of health care organizations using patient and family engagement strategies to enhance the use and adoption of health ITs, specifically. This study aimed to answer the following three research questions (RQs): (1) what current frameworks or theories have been used to guide patient and family engagement in health IT adoption, use, implementation, selection, and evaluation?, (2) what studies have been done on patient and family engagement strategies in health IT adoption, use, implementation, selection, and evaluation?, and (3) what patient and family engagement frameworks, studies, or resources identified in the literature can be applied to health IT adoption, use, implementation, selection, and evaluation? This scoping review used a five-step framework developed by Arksey and O'Malley and adapted by Levac et al. These steps include the following: (1) identifying the RQ, (2) identifying relevant studies, (3) selecting studies, (4) charting relevant data, and (5) summarizing and reporting the result. Retrieved academic and grey literature records were evaluated using a literature review software based on inclusion and exclusion criteria by two independent reviewers. If consensus was not achieved, two reviewers would resolve conflicts by discussion. Research findings and strategies were extracted from the studies and summarized in data tables. A total of 35 academic articles and 23 gray literature documents met the inclusion criteria. In total, 20 of the 35 included studies have been published since 2017. Frameworks found include the patient engagement framework developed by Healthcare Information and Management Systems Society and the patient and family engagement framework proposed by Carman et al. Effective strategies include providing patients with clear expectations and responsibilities and providing reimbursement for time and travel. The gray literature sources outlined key considerations for planning and supporting engagement initiatives such as providing patients with professional development opportunities, and embedding patients in existing governance structures. Several studies have reported their findings regarding successful strategies to engage patients and family members in health IT initiatives and the positive impact that can emerge when patients and family members are engaged in such initiatives in an effective manner. Currently, no framework has consolidated all of the key strategies and considerations that were found in this review to guide health care organizations when engaging patients and family members in a health IT-specific project or initiative. Further research to evaluate and validate the existing strategies would be of value.

Climate change is a well-recognized threat to lake ecosystems and, although there likely exists geographic variation in the sensitivity of lakes to climate, broad-scale, longterm studies are needed to understand this variation. Further, the potential mediating role of local to regional ecological context on these responses is not well documented. In this study, we examined relationships between climate and water clarity in 365 lakes from 1981 to 2010 in two distinct regions in the northeastern and midwestern United States. We asked (1) How do climate–water-clarity relationships vary across watersheds and between two geographic regions? and (2) Do certain characteristics make some lakes more climate sensitive than others? We found strong differences in climate–water-clarity relationships both within and across the two regions. For example, in the northeastern region, water clarity was often negatively correlated with summer precipitation (median correlation = −0.32, n = 160 lakes), but was not correlated with summer average maximum temperature (median correlation = 0.09, n = 205 lakes). In the midwestern region, water clarity was not related to summer precipitation (median correlation = −0.04), but was often negatively correlated with summer average maximum temperature (median correlation = −0.18). There were few strong relationships between local and sub-regional ecological context and a lake’s sensitivity to climate. For example, ecological context variables explained just 16–18% of variation in summer precipitation sensitivity, which was most related to total phosphorus, chlorophyll a, lake depth, and hydrology in both regions. Sensitivity to summer maximum temperature was even less predictable in both regions, with 4% or less of variation explained using all ecological context variables. Overall, we identified differences in the climate sensitivity of lakes across regions and found that local and sub-regional ecological context weakly influences the sensitivity of lakes to climate. Our findings suggest that local to regional drivers may combine to influence the sensitivity of lake ecosystems to climate change, and that sensitivities among lakes are highly variable within and across regions. This variability suggests that lakes are sensitive to different aspects of climate change (temperature vs. precipitation) and that responses of lakes to climate are heterogeneous and complex.

Khat, a naturally growing stimulant, has seen a significant increase in both consumption and cultivation in eastern Ethiopia. This reliance on khat in the region comes despite its known physiological complications, with users unable to restrict khat use due to its pervasive impact on their livelihood. This qualitative study sought to understand the meaning that those in eastern Ethiopia attribute to khat and explore their firsthand experiences with the substance. In June and July of 2023, six unstructured interviews were conducted among residents of the Haramaya District in Ethiopia. To promote a holistic comprehension of the participants’ lived experiences, an interpretative phenomenological analysis approach was employed when collecting and analyzing the data. Participant responses were coded independently from one another by two different researchers identifying superordinate and corresponding subordinate themes. Among the participants, six superordinate themes were captured: economic backbone of the region, market disruption & fluctuation, pesticide use, societal relationships around khat, applications of khat, and access to healthcare. The participants’ responses indicated that the normalization of khat use, coupled with the downplaying of its addictive potential, has established a framework where khat consumption is not only allowed but, in some cases, even encouraged. The unique interplay between communal practice and individual preservation creates a cyclical effect of using khat to supplement energy to farm khat and then sell or stimulate further work on their farm. This study illuminates the transitionfrom what was once the traditional or spiritual use of khat, to a more practical use for ensuring economic livelihood.

Connectivity of groundwater flow within crystalline-rock aquifers controls the sustainability of abstraction and baseflow to rivers, yet is often poorly constrained at a catchment scale. Here groundwater connectivity in a sheared gneiss aquifer is investigated by studying the intensively abstracted Berambadi catchment (84 km2) in the Cauvery River Basin, southern India, with geological characterisation, aquifer properties testing, hydrograph analysis, hydrochemical tracers and a numerical groundwater flow model. The study indicates a well-connected system, both laterally and vertically, that has evolved with high abstraction from a laterally to a vertically dominated flow system. Likely as a result of shearing, a high degree of lateral connectivity remains at low groundwater levels. Because of their low storage and logarithmic reduction in hydraulic conductivity with depth, crystalline-rock aquifers in environments such as this, with high abstraction and variable seasonal recharge, constitute a highly variable water resource, meaning farmers must adapt to varying water availability. Importantly, this study indicates that abstraction is reducing baseflow to the river, which, if also occurring in other similar catchments, will have implications downstream in the Cauvery River Basin.

Ecological inference requires integrating information across scales. This integration creates a complex spatial dependence structure that is most accurately represented by fully non-stationary models. However, ecologists rarely use these models because they are difficult to estimate and interpret. Here, we facilitate the use of fully non-stationary models in ecology by improving the interpretability of a recently developed non-stationary model and applying it to improve our understanding of the spatial processes driving lake eutrophication. We reformulated a model that incorporates non-stationary correlation by adding environmental predictors to the covariance function, thereby building on the intuition of mean regression. We created ellipses to visualize how data at a given site correlate with their surroundings (i.e., the range and directionality of underlying spatial processes). We applied this model to describe the spatial dependence structure of variables related to lake eutrophication across two different regions: a Midwestern United States region with highly agricultural landscapes, and a Northeastern United States region with heterogeneous land use. For the Midwest, increases in forest cover increased the homogeneity of the residual spatial structure of total phosphorus, indicating that macroscale processes dominated this nutrient’s spatial structure. Conversely, high forest cover and baseflow reduced the spatial homogeneity of chlorophyll a residuals, indicating that microscale processes dominated for chlorophyll a in the Midwest. In the Northeast, increases in urban land use and baseflow decreased the homogeneity of phosphorus concentrations indicating the dominance of microscale processes, but none of our covariates were strongly associated with the residual spatial structure of chlorophyll a. Our model showed that the spatial dependence structure of environmental response variables shifts across space. It also helped to explain this structure using ecologically relevant covariates from different scales whose effects can be interpreted intuitively. This provided novel insight into the processes that lead to eutrophication, a complex and pervasive environmental issue.