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The Scanning Habitable Environments with Raman and Luminescence for Organics and Chemicals (SHERLOC) is a robotic arm-mounted instrument onboard NASA’s Perseverance rover. SHERLOC combines imaging via two cameras with both Raman and fluorescence spectroscopy to investigate geological materials at the rover’s Jezero crater field site. SHERLOC requires in situ calibration to monitor the health and performance of the instrument. These calibration data are critically important to ensure the veracity of data interpretation, especially considering the extreme martian environmental conditions where the instrument operates. The SHERLOC Calibration Target (SCT) is located at the front of the rover and is exposed to the same atmospheric conditions as the instrument. The SCT includes 10 individual targets designed to meet all instrument calibration requirements. An additional calibration target is mounted inside the instrument’s dust cover. The targets include polymers, rock, synthetic material, and optical pattern targets. Their primary function is calibration of parameters within the SHERLOC instrument so that the data can be interpreted correctly. The SCT was also designed to take advantage of opportunities for supplemental science investigations and includes targets intended for public engagement. The exposure of materials to martian atmospheric conditions allows for opportunistic science on extravehicular suit (i.e., “spacesuit”) materials. These samples will be used in an extended study to produce direct measurements of the expected service lifetimes of these materials on the martian surface, thus helping NASA facilitate human exploration of the planet. Other targets include a martian meteorite and the first geocache target to reside on another planet, both of which increase the outreach and potential of the mission to foster interest in, and enthusiasm for, planetary exploration. During the first 200 sols (martian days) of operation on Mars, the SCT has been analyzed three times and has proven to be vital in the calibration of the instrument and in assisting the SHERLOC team with interpretation of in situ data.

The Scanning Habitable Environments with Raman and Luminescence for Organics and Chemicals (SHERLOC) is a robotic arm-mounted instrument on NASA’s Perseverance rover. SHERLOC has two primary boresights. The Spectroscopy boresight generates spatially resolved chemical maps using fluorescence and Raman spectroscopy coupled to microscopic images (10.1 μm/pixel). The second boresight is a Wide Angle Topographic Sensor for Operations and eNgineering (WATSON); a copy of the Mars Science Laboratory (MSL) Mars Hand Lens Imager (MAHLI) that obtains color images from microscopic scales (∼13 μm/pixel) to infinity. SHERLOC Spectroscopy focuses a 40 μs pulsed deep UV neon-copper laser (248.6 nm), to a ∼100 μm spot on a target at a working distance of ∼48 mm. Fluorescence emissions from organics, and Raman scattered photons from organics and minerals, are spectrally resolved with a single diffractive grating spectrograph with a spectral range of 250 to ∼370 nm. Because the fluorescence and Raman regions are naturally separated with deep UV excitation ( 250 nm), the Raman region ∼ 800 – 4000 cm−1 (250 to 273 nm) and the fluorescence region (274 to ∼370 nm) are acquired simultaneously without time gating or additional mechanisms. SHERLOC science begins by using an Autofocus Context Imager (ACI) to obtain target focus and acquire 10.1 μm/pixel greyscale images. Chemical maps of organic and mineral signatures are acquired by the orchestration of an internal scanning mirror that moves the focused laser spot across discrete points on the target surface where spectra are captured on the spectrometer detector. ACI images and chemical maps ( 100 μm/mapping pixel) will enable the first Mars in situ view of the spatial distribution and interaction between organics, minerals, and chemicals important to the assessment of potential biogenicity (containing CHNOPS). Single robotic arm placement chemical maps can cover areas up to 7x7 mm in area and, with the 10 min acquisition time per map, larger mosaics are possible with arm movements. This microscopic view of the organic geochemistry of a target at the Perseverance field site, when combined with the other instruments, such as Mastcam-Z, PIXL, and SuperCam, will enable unprecedented analysis of geological materials for both scientific research and determination of which samples to collect and cache for Mars sample return.

This study examined symptoms reported by patients after open-ended questioning vs those systematically assessed using a 48-question survey. Consecutive patients referred to the palliative medicine program at the Cleveland Clinic Foundation were screened. Open-ended questions were asked initially followed by a 48-item investigator-developed symptom checklist. Each symptom was rated for severity as mild, moderate, or severe. Symptom distress was also evaluated. Data were collected using standardized pre-printed forms. Two hundred and sixty-five patients were examined and 200 were eligible for assessment. Of those assessed, the median age was 65 years (range 17-90), and median ECOG performance status was 2 (range 1-4). A total of 2,397 symptoms were identified, 322 volunteered and 2,075 by systematic assessment. The median number of volunteered symptoms was one (range zero to six). Eighty-three percent of volunteered symptoms were moderate or severe and 17% mild. Ninety-one percent were distressing. Fatigue was the most common symptom identified by systematic assessment but pain was volunteered most often. The median number of symptoms found using systematic assessment was ten (0-25). Fifty-two percent were rated moderate or severe and 48% mild. Fifty-three percent were distressing. In total, 69% of 522 severe symptoms and 79% of 1,393 distressing symptoms were not volunteered. Certain symptoms were more likely to be volunteered; this was unaffected by age, gender, or race. The median number of symptoms found using systematic assessment was tenfold higher (p<0.001) than those volunteered. Specific detailed symptom inquiry is essential for optimal palliation in advanced disease.

We, the undersigned, stand as a unified community of stakeholders and key opinion leaders deeply concerned about forced opioid tapering in patients receiving longterm prescription opioid therapy for chronic pain. This is a large-scale humanitarian issue. Our specific concerns involve: • rapid, forced opioid tapering among outpatients; • mandated opioid tapers that require aggressive opioid dose reductions over a defined period, even when that period is an extended one. Opioid tapering guidelines were created, in part, to decrease harm to patients resulting from high-dose opioid therapy for chronic pain. However, countless “legacy patients” with chronic pain who were progressively escalated to high opioid doses, often over many years, now face additional and very serious risks resulting from rapid tapering or related policies that mandate extreme dose reductions that are aggressive and unrealistic.

Background Carbapenemase-producing Enterobacterales (CPE) are associated with substantial morbidity and mortality with limited treatment options and have an ability to spread rapidly in healthcare settings. We analyzed surveillance data from the Canadian Nosocomial Infection Surveillance Program to describe trends and the epidemiology of CPE from 2010 to 2023. Methods Participating acute-care hospitals submitted eligible isolates to the National Microbiology Laboratory for detection of carbapenemase genes. Trained infection control professionals applied standardized definitions to collect epidemiological data by chart review from 30–97 hospitals from 2010 to 2023. Results The national incidence of CPE infection (0.03 to 0.14 per 10,000 patient days; R 2  = 0.76) and colonization (0.02 to 0.78 per 10,000 patient days; R 2  = 0.83) increased exponentially from 2010 to 2023. We identified rapidly rising rates of healthcare-associated (HA) CPE infections from 2019 to 2023 (0.05 to 0.09 per 10,000 patient-days, p  = 0.04), attributed to select hospitals (7/97) which accounted for half (53%) of all HA-CPE infections in 2023. Similarly, we identified that 2023 HA-CPE colonization rates were highest in medium (201–499 beds) and large (≥500 beds) hospitals in the Central region. Most patients did not report international travel (66%) nor receipt of medical care abroad (74%). Travel and receipt of medical care were less commonly reported among bla KPC associated cases (7.1% and 5.3% respectively) compared to bla NDM (55% and 45% respectively) and bla OXA-48 (57% and 39%) associated cases. Furthermore, bla KPC was the predominant carbapenemase among all HA-CPE isolates (62%, 950/1,534). Conclusions Surveillance data from a national network of Canadian acute care hospitals indicates that while the incidence of CPE in Canada remains low, it is accelerating at an exponential rate. Our findings suggest that nosocomial transmission is driving the recent increase in CPE incidence in Canada. Improved infection control measures and antimicrobial stewardship as well as access to newer antimicrobials are all urgently needed.

Commensal leucothoid amphipods have been collected from the branchial chambers of their ascidian hosts throughout the Ryukyu Archipelago, Japan. Seven new species are described in two genera with valuable location data and host records. An identification key to ascidian-dwelling Leucothoidae of the Ryukyu Archipelago is provided.

BackgroundLaparoscopic cholecystectomy with common bile duct exploration (LCBDE) is equivalent in safety and efficacy to endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy (LC) while decreasing number of procedures and length of stay (LOS). Despite these advantages LCBDE is infrequently utilized. We hypothesized that formal, simulation-based training in LCBDE would result in increased utilization and improve patient outcomes across participating institutions.MethodsData was obtained from an on-going multi-center study in which simulator-based transcystic LCBDE training curricula were instituted for attending surgeons and residents. A 2-year retrospective review of LCBDE utilization prior to LCBDE training was compared to utilization up to 2 years after initiation of training. Patient outcomes were analyzed between LCBDE strategy and ERCP strategy groups using χ2, t tests, and Wilcoxon rank tests.ResultsA total of 50 attendings and 70 residents trained in LCBDE since November 2020. Initial LCBDE utilization rate ranged from 0.74 to 4.5%, and increased among all institutions after training, ranging from 9.3 to 41.4% of cases. There were 393 choledocholithiasis patients analyzed using LCBDE (N = 129) and ERCP (N = 264) strategies. The LCBDE group had shorter median LOS (3 days vs. 4 days, p < 0.0001). No significant differences in readmission rates between LCBDE and ERCP groups (4.7% vs. 7.2%, p = 0.33), or in post-procedure pancreatitis (0.8% v 0.8%, p > 0.98). In comparison to LCBDE, the ERCP group had higher rates of bile duct injury (0% v 3.8%, p = 0.034) and fluid collections requiring intervention (0.8% v 6.8%, p < 0.009) secondary to cholecystectomy complications. Laparoscopic antegrade balloon sphincteroplasty had the highest technical success rate (87%), followed by choledochoscopic techniques (64%).ConclusionSimulator-based training in LCBDE results in higher utilization rates, shorter LOS, and comparable safety to ERCP plus cholecystectomy. Therefore, implementation of LCBDE training is strongly recommended to optimize healthcare utilization and management of patients with choledocholithiasis.

Commensal leucothoid amphipods have been collected from the canals of their sponge hosts throughout the Ryukyu Archipelago, Japan. Eleven new species are described in the genus Leucothoe with valuable location data and host records. An identification key to sponge-dwelling Leucothoidae of the Ryukyu Archipelago is provided.

Commensal leucothoid amphipods have been collected from coral rubble samples throughout the Ryukyu Archipelago, Japan. Seven new species are described in two generawith valuable location data. A new locality is presented for Paranamixis misakiensis Thomas, 1997. An identification key to all described Leucothoidae of the Ryukyu Archipelago is provided.