Explore the vast range of titles available.

\"It has become clear to the Jao and their human and Lleix partners that to defeat the Ekhat who have been terrorizing the galaxy for eons, they need more allies. An exploration fleet created by Earth's humans is sent out but after a long search, all the expedition finds are dead worlds slaughtered by the Ekhat. Do they continue to search down the galactic arm in which Earth and the Jao worlds like or make an astounding leap in another direction. Meanwhile, a new generation of Ekhat leaders are growing into power who have not forgotten the damage the Jao have done to them over the years. It's up to the Jao-human-Lleix confederation and the new allies they make to survive the onslaught and turn the tables on the Ekhat\"-- Provided by publisher.

Unearthing the effects of surface water and groundwater interactions on subsurface biogeochemical reactions is crucial for developing a more mechanistic understanding of carbon and energy flow in aquifer ecosystems. To examine physiological characteristics across groundwater microbial communities that experience varying degrees of interaction with surface waters, we investigated 10 springs and a river sink and rise system in north central Florida that discharge from and/or mix with the karstic upper Floridan aquifer (UFA). Groundwater with longer residence times in the aquifer had lower concentrations of dissolved oxygen, dissolved and particulate organic carbon, and microbial biomass, as well as the lowest rates of respiration (0.102 to 0.189 mgO2L-1d-1) and heterotrophic production (198 to 576 µgCL-1d-1). Despite these features, oligotrophic UFA groundwater (< 0.5 mg C L−1) contained bioavailable organic matter that supported doubling times (14 to 62 h) and cell-specific production rates (0.0485 to 0.261 pmol C per cell per hour) comparable to those observed for surface waters (17 to 20 h; 0.105 to 0.124 pmol C per cell per hour). The relatively high specific rates of dissimilatory and assimilatory metabolism indicate a subsurface source of labile carbon to the groundwater (e.g., secondary production and/or chemoautotrophy). Our results link variations in UFA hydrobiogeochemistry to the physiology of its groundwater communities, providing a basis to develop new hypotheses related to microbial carbon cycling, trophic hierarchy, and processes generating bioavailable organic matter in karstic aquifer ecosystems.

This qualitative, 8-month study analyzed first-grade children’s playful responses to literature in the classroom context. The broad purpose of this research was to investigate the ways that children construct meaning as they respond to literature through play as a form of reader response. The findings presented in this paper highlight the ways the children interpreted and reflected upon body image and ideals of beauty and the ways in which they enacted/performed gender and gender roles as they responded to literature through play. These findings suggest that, as critical readers of texts, children demonstrate great depth in their explorations and analyses of gender and beauty through their responsive play, that the potential for play as a form of reader response is immense, and that the intersection of responsive play and young children’s critical literacies requires further investigation, in and out of the classroom setting.

In order to create and foster learning spaces that build upon children’s knowledge and experiences, we must respect and value their ways of knowing and being, including their play. Accordingly, this study highlights the ways that young children (re)imagined spaces, materials, and identities through their digital play in an analog (containing no physical, digital-based toys/materials) preschool classroom. This qualitative study utilized a framework of children’s play as murmuration (a transmodal assemblage), to analyze and discuss the children’s various digital play engagements. Three main themes were identified within/across these engagements, including the ways the children: (re)imagined the digital, drew from popular digital culture and media to make connections and construct meaning, and composed digital identities. Insights highlight the ways the children set aside perceived rules for materials, objects, spaces, and identities and created space for critically (re)envisioned ideas, concepts, realities, and futures to emerge. We encourage educators to continue to create and foster classroom spaces that value and build upon children’s playful ways of knowing, being, and becoming in the digital world.

ObjectiveTo assess the safety and efficacy of ixekizumab, a monoclonal antibody that inhibits interleukin-17A, in a double-blind phase III trial enrolling patients with active psoriatic arthritis (PsA).MethodsPatients naive to biologic therapy with active PsA were randomised to subcutaneous injections of placebo (N=106), adalimumab 40 mg once every 2 weeks (active reference; N=101), ixekizumab 80 mg once every 2 weeks (IXEQ2W) (N=103), or ixekizumab 80 mg once every 4 weeks (IXEQ4W) (N=107). Both ixekizumab regimens included a 160-mg starting dose. The primary objective was to assess the superiority of IXEQ2W or IXEQ4W versus placebo as measured by the proportion of patients achieving an American College of Rheumatology 20 (ACR20) response at week 24.ResultsSignificantly more patients treated with ixekizumab achieved an ACR20 response with IXEQ2W (62.1%) or IXEQ4W (57.9%) than placebo (30.2%) (p≤0.001; non-responder imputation method). Disease activity and functional disability were significantly improved with both ixekizumab doses versus placebo at weeks 12 and 24, and there was significantly less progression of structural damage at week 24 (p≤0.01). Clearance of plaque psoriasis was greater with ixekizumab than placebo (p≤0.001). Efficacy results with adalimumab, the active reference arm, showed significant improvements versus placebo. Treatment-emergent adverse events were more frequent with ixekizumab (65.7–66.4%) and adalimumab (64.4%) than placebo (47.2%) (p<0.05).ConclusionsIn biologic-naive patients with active PsA, ixekizumab treatment resulted in improvements in disease activity and physical function, as well as in the inhibition of structural damage progression. Overall, adverse events were more frequent in all active groups compared with placebo.Trial registration numberNCT01695239; EudraCT2011-002326-49; Results.

K.L. Flint: None. H. Jueppner: None. M. Reyes: None. E.W. Yu: None. Introduction: Pseudohypoparathyroidism (PHP) refers to the set of diseases characterized by end organ resistance to PTH and frequently other hormones, particularly TSH. PHP1A and PHP1B are the most common subtypes of PHP that lead to PTH-resistance at the level of the proximal renal tubules, but not the distal tubules or bones. Clinical Case: A 27 year old female presented to clinic with chronic hypocalcemia and elevated PTH. Seven years prior to the visit, she had traumatic fractures of her face and humerus and was found to have hypocalcemia to 7.7 mg/dl (normal 8.5-10.5 mg/dl). Her hypocalcemia went untreated at that time. In the year prior to the current visit, her serum calcium was 6.9-7.6 mg/dl with normal albumin, and PTH was markedly elevated to 991 pg/ml (normal 10-60 pg/ml). She was not taking calcium supplements, reported low dietary calcium, and denied bony pain or dental problems. She had delayed menarche (age 17). Exam was notable for BMI 41, positive Chvostek’s sign, and no overt brachydactyly or other features of Albright’s hereditary osteodystrophy. Labs were notable for elevated bone-specific alkaline phosphatase 260 IU/L (normal 12.1-42.7 IU/L), normal 25-hydroxy-vitamin D, phosphorus, albumin, renal function, and thyroid hormone. Imaging demonstrated endosteal resorption, possible foreshortening of the left fourth metatarsal, and a lucent lesion in the left foot consistent with a brown tumor due to longstanding secondary hyperparathyroidism. MLPA (multiplex ligation-dependent probe amplification) provided no evidence for a deletion or duplication at GNAS. MS-MLPA (methylation-sensitive MLPA) revealed loss-of-methylation at the maternal GNAS differentially methylated regions (DMRs) (A/B, XL, and AS) and gain-of-methylation at the paternal NESP DMR; these findings are consistent with sporadic PHP1B. Six microsatellite markers in the chr20q13 region showed heterozygosity, making a duplication of the paternal chromosome 20q (patUPD20q) unlikely. We started treatment with calcium supplements and calcitriol, but the patient missed her follow-up lab appointment. Conclusions: PHP1B is a rare condition in which patients have PTH-resistance at the level of the proximal renal tubules but not at the bones, leading to hypocalcemia and secondary hyperparathyroidism. When left untreated, longstanding hyperparathyroidism can lead to endosteal bone resorption and osteolytic lesions termed brown tumors. Although PHP1B is typically diagnosed in puberty, it is important to include PHP in the differential of an adult presenting with hypocalcemia and hyperparathyroidism to prevent life-threatening complications of severe calcium and PTH imbalance. Genetic and epigenetic testing can help differentiate between autosomal dominant forms caused by heritable genetic changes, and sporadic forms that have characteristic epigenetic changes without a clear genetic defect. Saturday, June 1, 2024

This study uses a Vygotskian approach and a socio-cultural lens, as well as the Transactional Reading Theory to investigate how social interactions and literary transactions can combine through buddy reading to empower young readers and promote literacy in a first grade classroom. The research focuses on how literary transaction and social interaction work together to facilitate emergent and early readers in a ‘partner/buddy’ reading approach. The research question asked whether or not ‘partner/buddy’ reading can promote literacy through social interaction, and yielded three major themes, including the use of reading strategies to scaffold learning, making connections with and to the text in order to construct meaning, and using play as a type of social interaction and motivational method. The findings suggest that buddy reading as a classroom tool can effectively promote literacy and learning in a cooperative setting.

Abstract Introduction Adherence to PAP therapy is a significant challenge in children, particularly those with developmental delay and multiple medical problems. Many insurance companies have adopted Medicare’s criteria for PAP coverage, even in pediatric patients. Children on PAP therapy, particularly those with special medical needs, often require > 90 days to achieve the definition of PAP adherence (≥ 4 hours of use, >70% of nights, for 30 consecutive days). Methods A retrospective chart review was performed on 6 children on PAP therapy at Children’s Hospital of Wisconsin. Data was collected to describe the efforts and process to attain adherence criteria in these children. Results We reviewed the charts of 5 males and 1 female with average age of 7.7 years. Reasons for PAP were obstructive sleep apnea and hypoventilation. Comorbidities included obesity, seizures, brainstem glioma, anxiety, ependymoma, myotubular myopathy, congenital myopathy status post heart transplant, Chiari malformation, Albright hereditary osteodystrophy, and Trisomy 21. The time to adherence was 6–66 months, with an average of 32.3 months. In order to maintain insurance coverage for PAP, 2 required a letter of medical necessity and 2 required phone calls to their durable medical equipment company. Overall, adherence was achieved in these children after an average of 6 clinic visits, 6 follow-up phone calls, 4 mask fittings in the sleep lab, and 3 PAP titration studies. Conclusion In order to tolerate PAP, medically complex children may require multiple pressure adjustments, mask changes and/or clinic assessments, a process which can take several years to complete. Hence, allowing extended periods of time for acclimatization to PAP therapy in pediatric patients is essential to achieving and maintaining PAP adherence. Support (If Any):