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Background The field of implementation science is growing and becoming more complex. When teaching new learners, providing a clear definition of implementation science and a description of “its place” among related fields can be difficult. The author developed a teaching tool using very simple language to help learners grasp key concepts in implementation science. The teaching tool The tool consists of a slide (visual aid) which provides simple and jargon-free definitions of implementation science, implementation strategies, and implementation outcomes, as well as a description of how implementation science relates to “effectiveness” research focusing on clinical/preventive interventions. Conclusion The tool could be useful to new students in the field, as well as other scholars or stakeholders in need of a brief and plain language introduction to key concepts in implementation science.

Tumors use several strategies to evade the host immune response, including creation of an immune-suppressive and hostile tumor environment. Tissue hypoxia due to inadequate blood supply is reported to develop very early during tumor establishment. Hypoxic stress has a strong impact on tumor cell biology. In particular, tissue hypoxia contributes to therapeutic resistance, heterogeneity and progression. It also interferes with immune plasticity, promotes the differentiation and expansion of immune-suppressive stromal cells, and remodels the metabolic landscape to support immune privilege. Therefore, tissue hypoxia has been regarded as a central factor for tumor aggressiveness and metastasis. In this regard, manipulating host–tumor interactions in the context of the hypoxic tumor microenvironment may be important in preventing or reverting malignant conversion. We will discuss how tumor microenvironment-driven transient compositional tumor heterogeneity involves hypoxic stress. Tumor hypoxia is a therapeutic concern since it can reduce the effectiveness of conventional therapies as well as cancer immunotherapy. Thus, understanding how tumor and stromal cells respond to hypoxia will allow for the design of innovative cancer therapies that can overcome these barriers. A better understanding of hypoxia-dependent mechanisms involved in the regulation of immune tolerance could lead to new strategies to enhance antitumor immunity. Therefore, discovery and validation of therapeutic targets derived from the hypoxic tumor microenvironment is of major importance. In this context, critical hypoxia-associated pathways are attractive targets for immunotherapy of cancer. In this review, we summarize current knowledge regarding the molecular mechanisms induced by tumor cell hypoxia with a special emphasis on therapeutic resistance and immune suppression. We emphasize mechanisms of manipulating hypoxic stress and its associated pathways, which may support the development of more durable and successful cancer immunotherapy approaches in the future.

Background. Marked increases in Clostridium difficile infection (CDI) incidence, driven by epidemic strain spread, is a global phenomenon. Methods. The Clostridium difficile Ribotyping Network (CDRN) was established in 2007 as part of enhanced CDI surveillance in England, to facilitate the recognition and control of epidemic strains. We report on changes in CDI epidemiology in England in the first 3 years of CDRN. Results. CDRN received 12 603 fecal specimens, comprising significantly (P < .05) increasing numbers and proportions of national CDI cases in 2007–2008 (n = 2109, 3.8%), 2008–2009 (n = 4774, 13.2%), and 2009–2010 (n = 5720, 22.3%). The C. difficile recovery rate was 90%, yielding 11 294 isolates for ribotyping. Rates of 9 of the 10 most common ribotypes changed significantly (P < .05) during 2007–2010. Clostridium difficile ribotype 027 predominated, but decreased markedly from 55% to 36% and 21% in 2007–2008, 2008–2009, and 2009–2010, respectively. The largest regional variations in prevalence occurred for ribotypes 027, 002, 015, and 078. Cephalosporin and fluoroquinolone use in CDI cases was reported significantly (P < .05) less frequently during 2007–2010. Mortality data were subject to potential reporting bias, but there was a significant decrease in CDI-associated deaths during 2007–2010, which may have been due to multiple factors, including reduced prevalence of ribotype 027. Conclusions. Access to C. difficile ribotyping was associated with significant changes in the prevalence of epidemic strains, especially ribotype 027. These changes coincided with markedly reduced CDI incidence and related mortality in England. CDI control programs should include prospective access to C. difficile typing and analysis of risk factors for CDI and outcomes.

Global models of biophysical suitability for oil palm consistently rank Brazil as having the greatest potential for expansion, with estimates as high as 238 Mha of suitable lands. In 2010, Brazil launched the Sustainable Palm Oil Production Program (SPOPP) to incentivize oil palm development without deforestation on as much as 30 Mha. Here we examine oil palm expansion before and after the SPOPP's launch. In Pará, the major oil palm producing state in Brazil, we analyze the extent and change in oil palm cultivation from 2006−2014 using satellite imagery, ground-truthed verification, site-based interviews, and rural environmental (land) registration data. Between 2006−2014, oil palm area (≥9 ha) expanded >200% to ~219 000 ha. Of the ~148 000 ha of oil palm developed, ~91% converted pasturelands while ~8% replaced natural vegetation, including intact and secondary forests. Although >80% of all oil palm parcels rest <0.5 km from intact forests, direct conversion of intact forests declined from ~4% pre-SPOPP (2006−2010) to <1% post-SPOPP (2010−2014). Despite low and declining deforestation rates associated with oil palm expansion in Pará, our results also show a low area of oil palm development overall compared with reported land suitability. To explore potential contributing factors, we conducted semi-structured interviews with researchers, company representatives, and government officials involved in the sector to characterize the perceived factors influencing oil palm development and the role of agro-ecological suitability mapping among them. Interviews indicated that: (1) individual effects of suitability mapping efforts to encourage oil palm expansion on cleared areas, i.e. without deforestation, cannot be disentangled from pre-existing public and private deforestation reduction initiatives; and, (2) socio-economic constraints, e.g. high relative production costs and limited familiarity with this crop, appear to partially explain the major discrepancy between estimated potential suitable areas with realized oil palm development.

Understanding and minimizing coronavirus disease 2019 (COVID‐19) vaccine hesitancy is critical to population health and minimizing health inequities, which continue to be brought into stark relief by the pandemic. We investigate questions regarding vaccine hesitancy in a sample (n = 1205) of Arkansas adults surveyed online in July/August of 2020. We examine relationships among sociodemographics, COVID‐19 health literacy, fear of COVID‐19 infection, general trust in vaccines, and COVID‐19 vaccine hesitancy using bivariate analysis and a full information maximum likelihood (FIML) logistic regression model. One in five people (21,21.86%) reported hesitancy to take a COVID‐19 vaccine. Prevalence of COVID‐19 vaccine hesitancy was highest among Black/African Americans (50.00%), respondents with household income less than $25K (30.68%), some college (32.17%), little to no fear of infection from COVID‐19 (62.50%), and low trust in vaccines in general (55.84%). Odds of COVID‐19 vaccine hesitancy were 2.42 greater for Black/African American respondents compared to White respondents (p < 0.001), 1.67 greater for respondents with some college/technical degree compared to respondents with a 4‐year degree (p < 0.05), 5.48 greater for respondents with no fear of COVID‐19 infection compared to those who fear infection to a great extent (p < 0.001), and 11.32 greater for respondents with low trust in vaccines (p < 0.001). Sociodemographic differences in COVID‐19 vaccine hesitancy raise concerns about the potential of vaccine implementation to widen existing health disparities in COVID‐19 related infections, particularly among Black/African Americans. Fear of infection and general mistrust in vaccines are significantly associated with vaccine hesitancy.

Background Beginners to the discipline of implementation science often struggle to determine whether their research questions “count” as implementation science. Main text In this paper, three implementation scientists share a heuristic tool to help investigators determine where their research questions fall in the translational research continuum. They use a “subway model” that envisions a journey to implementation research with stops along the way at efficacy and effectiveness research. Conclusions A series of structured questions about intervention efficacy, effectiveness, and implementation can help guide researchers to select research questions and appropriate study designs along the spectrum of translational research.

Interior Antarctica is among the most remote places on Earth and was thought to be beyond the reach of human impacts when Amundsen and Scott raced to the South Pole in 1911. Here we show detailed measurements from an extensive array of 16 ice cores quantifying substantial toxic heavy metal lead pollution at South Pole and throughout Antarctica by 1889 – beating polar explorers by more than 22 years. Unlike the Arctic where lead pollution peaked in the 1970s, lead pollution in Antarctica was as high in the early 20 th century as at any time since industrialization. The similar timing and magnitude of changes in lead deposition across Antarctica, as well as the characteristic isotopic signature of Broken Hill lead found throughout the continent, suggest that this single emission source in southern Australia was responsible for the introduction of lead pollution into Antarctica at the end of the 19 th century and remains a significant source today. An estimated 660 t of industrial lead have been deposited over Antarctica during the past 130 years as a result of mid-latitude industrial emissions, with regional-to-global scale circulation likely modulating aerosol concentrations. Despite abatement efforts, significant lead pollution in Antarctica persists into the 21 st century.

The Carrington Event of 1859 is considered to be among the largest space weather events of the last 150 years. We show that only one out of 14 well‐resolved ice core records from Greenland and Antarctica has a nitrate spike dated to 1859. No sharp spikes are observed in the Antarctic cores studied here. In Greenland numerous spikes are observed in the 40 years surrounding 1859, but where other chemistry was measured, all large spikes have the unequivocal signal, including co‐located spikes in ammonium, formate, black carbon and vanillic acid, of biomass burning plumes. It seems certain that most spikes in an earlier core, including that claimed for 1859, are also due to biomass burning plumes, and not to solar energetic particle (SEP) events. We conclude that an event as large as the Carrington Event did not leave an observable, widespread imprint in nitrate in polar ice. Nitrate spikes cannot be used to derive the statistics of SEPs. Key Points Most ice cores have no nitrate spike at 1859 Greenland cores have nitrate spikes, but these are normally from biomass burning Nitrate in ice cannot be used to derive SEP statistics

Refractory black carbon aerosols (rBC) emitted by biomass burning (fires) and fossil fuel combustion, affect global climate and atmospheric chemistry. In the Southern Hemisphere (SH), rBC is transported in the atmosphere from low- and mid-latitudes to Antarctica and deposited to the polar ice sheet preserving a history of emissions and atmospheric transport. Here, we present two high-resolution Antarctic rBC ice core records drilled from the West Antarctic Ice Sheet divide and Law Dome on the periphery of the East Antarctic ice sheet. Separated by ~3500 km, the records span calendar years 1850–2001 and reflect the rBC distribution over the Indian and Pacific ocean sectors of the Southern Ocean. Concentrations of rBC in the ice cores displayed significant variability at annual to decadal time scales, notably in ENSO-QBO and AAO frequency bands. The delay observed between rBC and ENSO variability suggested that ENSO does not directly affect rBC transport, but rather continental hydrology, subsequent fire regimes, and aerosol emissions. From 1850 to 1950, the two ice core records were uncorrelated but were highly correlated from 1950 to 2002 (cross-correlation coefficient at annual resolution: r = 0.54, p < 0.01) due to a common decrease in rBC variability. The decrease in ice-core rBC from the 1950s to late 1980s displays similarities with inventories of SH rBC grass fires and biofuel emissions, which show reduced emission estimates over that period.

Industrial agricultural plantations are a rapidly increasing yet largely unmeasured source of tropical land cover change. Here, we evaluate impacts of oil palm plantation development on land cover, carbon flux, and agrarian community lands in West Kalimantan, Indonesian Borneo. With a spatially explicit land change/carbon bookkeeping model, parameterized using high-resolution satellite time series and informed by socioeconomic surveys, we assess previous and project future plantation expansion under five scenarios. Although fire was the primary proximate cause of 1989–2008 deforestation (93%) and net carbon emissions (69%), by 2007–2008, oil palm directly caused 27% of total and 40% of peatland deforestation. Plantation land sources exhibited distinctive temporal dynamics, comprising 81% forests on mineral soils (1994–2001), shifting to 69% peatlands (2008–2011). Plantation leases reveal vast development potential. In 2008, leases spanned ∼65% of the region, including 62% on peatlands and 59% of community-managed lands, yet <10% of lease area was planted. Projecting business as usual (BAU), by 2020 ∼40% of regional and 35% of community lands are cleared for oil palm, generating 26% of net carbon emissions. Intact forest cover declines to 4%, and the proportion of emissions sourced from peatlands increases 38%. Prohibiting intact and logged forest and peatland conversion to oil palm reduces emissions only 4% below BAU, because of continued uncontrolled fire. Protecting logged forests achieves greater carbon emissions reductions (21%) than protecting intact forests alone (9%) and is critical for mitigating carbon emissions. Extensive allocated leases constrain land management options, requiring trade-offs among oil palm production, carbon emissions mitigation, and maintaining community landholdings.