Cancer care coordination in rural Hawaii: a focus group study

BACKGROUND

Rural populations consistently experience a disproportionate burden of cancer, including higher incidence and mortality rates, compared to the urban populations. Factors that are thought to contribute to these disparities include limited or lack of access to care and challenges with care coordination (CC). In Hawaii, many patients residing in rural areas experience unique challenges with CC as they require inter-island travel for their cancer treatment. In this focus group study, we explored the specific challenges and positive experiences that impact the CC in rural Hawaii cancer patients.

METHODS

We conducted two semi-structured focus group interviews with cancer patients receiving active treatment for any type of cancer (n = 8). The participants were recruited from the rural areas of Hawaii, specifically the Hawaii county and Kauai. Rural was defined using the Rural-Urban Commuting Area Codes (RUCA; rural ≥ 4). The focus group discussions were facilitated using open-ended questions to explore patients' experiences with CC.

RESULTS

Content analysis revealed that 47% of the discussions were related to CC-related challenges, including access to care (27.3%), insurance (9.1%), inter-island travel (6.1%), and medical literacy (4.5%). Other major themes from the discussions focused on facilitators of CC (30.3%), including the use of electronic patient portal (12.1%), team-based approach (9.1%), family caregiver support (4.5%), and local clinic staff (4.5%).

CONCLUSION

Our findings indicate that there are notable challenges in rural patients' experiences regarding their cancer care coordination. Specific factors such as the lack of oncologist and oncology services, fragmented system, and the lack of local general medical providers contribute to problems with access to care. However, there are also positive factors found through the help of facilitators of CC, notability the use of electronic patient portal, team-based approach, family caregiver support, and local clinic staff. These findings highlight potential targets of interventions to improve cancer care delivery for rural patients.

TRIAL REGISTRATION

Not required.

Exploring perspectives and insights of experienced voyagers on human health and Polynesian oceanic voyaging: A qualitative study

BACKGROUND

The Worldwide Voyage (WWV) was a 3-year (2014-2017) open-ocean voyage to circumnavigate the world using Indigenous knowledge and navigational skills aboard Hōkūle'a, a traditionally designed Native Hawaiian (NH) voyaging canoe (wa'a kaulua). Each WWV segment included experienced crew and leadership who were recognized by their voyaging peers as highly experienced in Polynesian oceanic voyaging. This study explored the perceptions and insights of WWV-experienced ocean voyagers on the interconnection between human health and oceanic voyaging.

METHODOLOGY

A constructivist approach with a storytelling-based moderator guide was used to conduct focus groups and informant interviews of experienced crew and voyaging leadership. Participants were interviewed and recorded transcripts were analyzed using content analysis. Triangulation of analysis included secondary thematic review by two independent NH cultural practitioners and participant member checking. Purposive sampling was used to enroll 34 of 66 eligible highly experienced voyagers (leadership n = 6; crew n = 28) in 5 focus groups and 4 informant interviews.

RESULTS

Six themes emerged: 1) Indigenous context (spiritual and natural environment); 2) Importance of relationships and community; 3) Description of life on the canoe; 4) Holistic health; 5) Mindfulness, stress reduction and emotional health; and 6) Opportunities for intervention. Themes 1-5 were inductive and intricately interrelated, and theme 6 was deductive in that it directly resulted from a moderator guide question. Theme 6 offers strategies to improve the impact of voyaging and health well beyond the physical voyage with recommendations for improved transition back to land and developing a wa'a community context, which reflects a traditional voyaging experience.

CONCLUSIONS

Polynesian oceanic voyaging is strongly perceived as a positive and transformative holistic-health-promoting experience.

SIGNIFICANCE

Recommendations to promote generalizable health benefits of a voyaging lifestyle offers a promising and culturally grounded approach warranting future studies to understand mechanism and potential impact for improving health inequities.

Diel flight activity in response to attractants in the predatory beetle, Cathartus quadricollis (Coleoptera: Silvanidae) in macadamia nut in Hawaii

The diel flight activity in Cathartus quadricollis (Guerin-Meneville) (Coleoptera: Silvanidae), a predator of two important pests in Hawaii, coffee berry borer, Hypothenemus hampei (Ferrari) and tropical nut borer, Hypothenemus obscurus (F.) (Coleoptera: Curculionidae: Scolytinae) was studied in a macadamia nut orchard using yellow sticky traps baited with pheromone and fungal volatile attractants. The study was conducted at different months throughout the year and at different times during the lunar cycle (new moon and full moon). Flight activity peaked in the late hours of the photophase into the early hours of the scotophase, between 1830 and 2000 h; flight activity also occurred but to a lesser extent in the early morning hours between 0700 and 1030 h. Numbers of captured C. quadricollis during periods of flight activity were negatively correlated with wind speed. The implications of these findings for the development of optimal pest management strategies including biological control are discussed.

Chemical species recognition in an adaptive radiation of Hawaiian Tetragnatha spiders (Araneae: Tetragnathidae)

Studies of adaptive radiations have played a central role in our understanding of reproductive isolation. Yet the focus has been on human-biased visual and auditory signals, leaving gaps in our knowledge of other modalities. To date, studies on chemical signals in adaptive radiations have focused on systems with multimodal signalling, making it difficult to isolate the role chemicals play in reproductive isolation. In this study we examine the use of chemical signals in the species recognition and adaptive radiation of Hawaiian Tetragnatha spiders by focusing on entire communities of co-occurring species, and conducting behavioural assays in conjunction with chemical analysis of their silks using gas chromatography-mass spectrometry. Male spiders significantly preferred the silk extracts of conspecific mates over those of sympatric heterospecifics. The compounds found in the silk extracts, long chain alkyl methyl ethers, were remarkably species-specific in the combination and quantity. The differences in the profile were greatest between co-occurring species and between closely related sibling species. Lastly, there were significant differences in the chemical profile between two populations of a particular species. These findings provide key insights into the role chemical signals play in the attainment and maintenance of reproductive barriers between closely related co-occurring species.

Allopolyploid origin and diversification of the Hawaiian endemic mints

Island systems provide important contexts for studying processes underlying lineage migration, species diversification, and organismal extinction. The Hawaiian endemic mints (Lamiaceae family) are the second largest plant radiation on the isolated Hawaiian Islands. We generated a chromosome-scale reference genome for one Hawaiian species, Stenogyne calaminthoides, and resequenced 45 relatives, representing 34 species, to uncover the continental origins of this group and their subsequent diversification. We further resequenced 109 individuals of two Stenogyne species, and their purported hybrids, found high on the Mauna Kea volcano on the island of Hawai'i. The three distinct Hawaiian genera, Haplostachys, Phyllostegia, and Stenogyne, are nested inside a fourth genus, Stachys. We uncovered four independent polyploidy events within Stachys, including one allopolyploidy event underlying the Hawaiian mints and their direct western North American ancestors. While the Hawaiian taxa may have principally diversified by parapatry and drift in small and fragmented populations, localized admixture may have played an important role early in lineage diversification. Our genomic analyses provide a view into how organisms may have radiated on isolated island chains, settings that provided one of the principal natural laboratories for Darwin's thinking about the evolutionary process.

Challenges Faced by Rural Health Care Providers Caring for Parkinson's Disease Patients in Neighbor Islands of Hawai'i

When compared to their urban counterparts, rural regions have worse health outcomes and more challenges in health care access. As the only island state in the US, Hawai'i's unique geographic layout may magnify these disparities. However, there are limited publications on the impact of urban-rural disparities in health care in Hawai'i. The study team aimed to identify the challenges rural health care providers face when managing treatment of Parkinson's disease (PD), a complex disease. A self-administered survey was sent to 247 eligible providers who practiced in Hawai'i and prescribed PD medications from 2017-2019. The survey assessed: provider's comfort level in PD management; utilization and accessibility of health care services; perspective on barriers to PD care; and perspective on telemedicine. Providers were categorized into O'ahu providers (OP, urban) and neighbor island (Hawai'i, Kaua'i, and Maui) providers (NIP, rural). The final sample size was 44 providers (18% response rate). NIP were significantly less likely than OP to report access to social workers (P=.025), geriatric services (P=.001), and psychologist/psychiatrist/mental health professionals (P=.009). There were no statistical differences in: criteria used for PD diagnosis, resources utilized for PD education, and comfort in prescribing PD medications. The findings show that NIP are just as engaged and capable in providing PD care as OP. However, NIP encounter more limitations to accessibility, which can affect the quality of PD care that their rural patients receive. Further research is needed to understand how these limitations affect health-related outcomes in PD as well as other chronic diseases.

Native Hawaiians' Views on Depression and Preferred Behavioral Health Treatments: a Preliminary Qualitative Investigation

Behavioral health issues, especially depression, are a major health disparity concern for Native Hawaiians in Hawai'i. Following the cultural safety framework and contextual behavioral science approach to intervention development, the present preliminary qualitative investigation aimed to gather better insight into Native Hawaiians' views of depression and its causes as well as their preferred forms of behavioral health services. Data were initially collected from a 2-hour virtual focus group with three behavioral health service providers working with Native Hawaiians, followed by a total of 38 online one-on-one in-depth interviews with Native Hawaiian clients with depression (n = 19), behavioral health service providers working with Native Hawaiian adults (n = 9), and Native Hawaiian cultural leaders (n = 10). Our qualitative data suggested that Native Hawaiians tend to view depression contextually and socioculturally as the manifestation of one's vital connection to the 'āina (land), 'ohana (family; continuity from ancestry and future generations), community, culture/spirituality, and one's authentic self being disrupted. Our findings also suggested that Native Hawaiians often attribute these disruptions to disparities due to the ongoing impact of colonization, historical trauma, and cultural loss. As a preferred form of treatment for depression, participants recommended various Hawaiian cultural practices to be integrated into existing behavioral health services to nurture the above-mentioned vital connection.

Increased occurrence of the rare golden color morph of Pacific chub Kyphosus sandwicensis in a no-take marine reserve

Pacific chub, Kyphosus sandwicensis, are typically gray but some individuals display a golden color morph. We estimated that the frequency of occurrence of the golden morphs increased significantly from 2007 (1.9%) and 2012 (2.6%) to 2017 (5.0%) inside a no-take marine reserve around Nihoa Island in the Northwestern Hawaiian Islands. While sporadic observations of a golden color morph have been noted for several other marine fish species, we provide a quantitative estimate of changes in the frequency of occurrence of the morph within a wild marine population.

Racial Misclassification, Discrimination, Consciousness, and Self-Rated Health Among Native Hawaiian and Pacific Islander Adults in the USA

BACKGROUND

Medical researchers have historically utilized the variable of race uncritically, rarely defining race, rarely acknowledging it as a social construct, and often omitting information about how it was measured. In this study, we use the following definition of race: "a system of structuring opportunity and assigning value based on the social interpretation of how one looks." We examine the influence of racial misclassification, racial discrimination, and racial consciousness on the self-rated health of Native Hawaiian and Pacific Islanders (NHPI) living in the United States of America (USA).

METHODS

Our analysis used online survey data from a subgroup of NHPI adults living in the USA (n = 252) who were oversampled as part of a larger study of US adults (N = 2022). Respondents were recruited between September 7, 2021 and October 3, 2021, from an online opt-in panel of individuals across the USA. Statistical analyses include weighted and unweighted descriptive statistics for the sample, as well as a weighted logistic regression for poor/fair self-rated health.

RESULTS

Odds of poor/fair self-rated health were greater for women (OR = 2.72; 95% CI [1.19, 6.21]) and those who experienced racial misclassification (OR = 2.90; 95% CI [1.20, 7.05]). No other sociodemographic, healthcare, or race-related variables were significantly associated with self-rated health in the fully adjusted results.

CONCLUSIONS

Findings suggest that racial misclassification may be an important correlate of self-rated health among NHPI adults in the US context.

Finding Direction for Purpose Research in Hawai'i: A Narrative Review

Purpose is an important construct across contexts and cultures, with evidence suggesting it is strongly related to health, health behaviors, discrimination, and experiences of trauma. In this narrative review of the research on purpose in Hawai'i, the authors identify, critically analyze, and synthesize the extant literature found through a comprehensive literature search. It then discusses important cultural considerations for engaging in purpose research in Hawai'i, broadly, and with the Indigenous people of Hawai'i (Kānaka Maoli). The review presents findings on how sense of purpose levels differ between Hawai'i and the continental United States and risk factors or strengths critical in shaping the development of purpose in Hawai'i. Potential future directions for this line of inquiry conclude this review, with a particular emphasis on the need for integration of Kanaka Maoli ontology and values.

Exploring the Hawaiian Ala Wai Watershed with Zebrafish

The Ala Wai Canal is an artificial waterway in the tourist district of Waikiki in Honolulu, HI. Originally built to collect runoff from industrial, residential, and green spaces dedicated to recreation, the Ala Wai Canal has since experienced potent levels of toxicity due to this runoff entering the watershed and making it hazardous for both marine life and humans at current concentration, including Danio rerio (zebrafish). A community of learners at educations levels from high school to postbaccalaureate from Oahu, HI was connected through the Consortium for Increasing Research and Collaborative Learning Experiences (CIRCLE) distance research program. This team conducted research with an Investigator and team from Mayo Clinic in Rochester, MN, with the Ala Wai Canal as its primary subject. Through CIRCLE, research trainees sent two 32 oz bottles of Ala Wai- acquired water to a partnered laboratory at the Mayo Clinic in which zebrafish embryos were observed at differing concentrations of the sampled water against a variety of developmental and behavioral assays. Research trainees also created atlases of developmental outcomes in zebrafish following exposure to environmental toxins and tables of potential pesticide contaminants to enable the identification of the substances linked to structural defects and enhanced stress during Ala Wai water exposure experiments.

Hawaiian native herb Mamaki prevents dementia by ameliorating neuropathology and repairing neurons in four different mouse models of neurodegenerative diseases

Neurodegenerative diseases including Alzheimer's disease, frontotemporal dementia, and dementia with Lewy bodies are age-related disorders and the main cause of dementia. They are characterized by the cerebral accumulation of Aβ, tau, α-synuclein, and TDP-43. Because the accumulation begins decades before disease onset, treatment should be started in the preclinical stage. Such intervention would be long-lasting, and therefore, prophylactic agents should be safe, non-invasively taken by the patients, and inexpensive. In addition, the agents should be broadly effective against etiologic proteins and capable of repairing neurons damaged by toxic oligomers. These requirements are difficult to meet with single-ingredient pharmaceuticals but may be feasible by taking proper diets composed of multiple ingredients. As a source of such diets, we focused on the Hawaiian native herb Mamaki. From its dried leaves and fruits, we made three preparations: hot water extract of the leaves, non-extracted simple crush powder of the leaves, and simple crush powder of the fruits, and examined their effects on the cognitive function and neuropathologies in four different mouse models of neurodegenerative dementia. Hot water extract of the leaves attenuated neuropathologies, restored synaptophysin levels, suppressed microglial activation, and improved memory when orally administered for 1 month. Simply crushed leaf powder showed a higher efficacy, but simply crushed fruit powder displayed the strongest effects. Moreover, the fruit powder significantly enhanced the levels of brain-derived neurotrophic factor expression and neurogenesis, indicating its ability to repair neurons. These results suggest that crushed Mamaki leaves and fruits are promising sources of dementia-preventive diets.

Understanding Factors Affecting Health Providers' Perceptions of Pharmacist Roles in HPV Vaccine Administration

Human papillomavirus (HPV) is a viral infection that sexually active females and males may be exposed to in their lifetime. The HPV vaccine is highly recommended especially among children to protect them before their anticipated exposure to HPV, however, vaccination uptake in Hawai'i remains low. As of 2017, legislation allows pharmacists to vaccinate for adolescent vaccines with the potential to increase access and opportunities for patients to complete the HPV vaccine series. Physicians in Hawai'i were surveyed to examine physicians' awareness of this law, their perceptions of the role of pharmacists, and willingness to send adolescent patients to pharmacies; 137 responses were received and analyzed. Overall, 72% (n=99) of respondents were willing while 28% (n=38) were unwilling to send patients to pharmacies for vaccines. Physicians view pharmacists' role as helpful but have concerns regarding correct administration and tracking doses given. Results show potential for more physician-pharmacist collaborations through further education and trainings for pharmacists and health providers to increase physician referrals for adolescent vaccine services in pharmacies.

Three years of weekly DEMs, aerial orthomosaics and surveyed shoreline positions at Waikīkī Beach, Hawai'i

In this dataset, we present 128 coastal surveys conducted between 2018 and 2021 at Kahaloa Beach, also known as the Royal Hawaiian Beach, in Waikīkī, Hawai'i. Surveys were conducted on a near-weekly basis, providing a 0.5 m digital elevation model, an orthorectified image mosaic with 0.03 m resolution, and shoreline vectors at MHHW and MSL, along with a surveyed shoreline position for each survey. We captured overlapping images using a small Unoccupied Aerial System (sUAS), processing the imagery with photogrammetric software to produce orthomosaics and Digital Terrain Models (DTM). Simultaneously, the shoreline position and reference points for sUAS-derived products were surveyed using total station and rod-mounted surveying prism. A quality assessment of 424 randomly sampled points across two surveys showed normally distributed errors of DTM elevations (µ1 = 0.0060 m; σ1 = 0.0998 m; µ2 = 0.0035 m; σ2 = 0.0680). Elevation uncertainties were quantified as 95% confidence intervals (±0.0130 m and ±0.0095 m). These data are intended to encourage research on reef-fringed beaches and provide a dataset for evaluating the accuracy of satellite-derived shorelines at reef-fringed beaches.

Shower dehumidification to reduce nontuberculous mycobacteria aerosolization

OBJECTIVE

Nontuberculous mycobacteria (NTM) are environmentally acquired opportunistic pathogens that can cause recalcitrant lung disease. Prior reports have demonstrated links between shower use and infections, yet the aerosolization of NTM from showerheads, as well as the humidity levels that may modulate NTM aerosolization from showerheads is less studied. The objective of the current study was to investigate the role of humidity in NTM aerosolization among showers in homes located in a geographic area with high lung disease incidence, Hawai'i, and test whether deployment of a dehumidifier in well-ventilated bathrooms reduce NTM exposure.

RESULTS

Across two sampling events and five showers, existing NTM showerhead biofilms along with shower air were sampled at three points: pre-shower, post-shower, and post-dehumidification. In each of the sampling events, respiratory relevant NTM species were identified from shower biofilms, which were also detected in aerosolized shower air after showering events, but not after the shower was dehumidified and bathrooms vented. While sample size was small, these data suggest running a shower is a possible source of NTM aerosolization and using a commercial household dehumidifier in conjunction with opening bathroom doors and windows may be simple, cost-effective interventions to reduce environmental NTM exposures.

Exploring odontocete depredation rates in a pelagic longline fishery

Several odontocete species depredate catch and bait from fishing gear, resulting in their bycatch and causing substantial economic costs. There are no known mitigation methods for odontocete depredation in pelagic longline fisheries that are effective, do not harm odontocetes and are commercially viable. Understanding odontocetes' depredation strategies can contribute to mitigating this human-wildlife conflict. Using observer data from the Hawaii-based tuna longline fishery, this study summarized teleost and elasmobranch species-specific mean posterior odontocete depredation rates using a simple Bayesian binomial likelihood estimator with a Bayes-Laplace prior. Depredation rates of species with sufficient sample sizes ranged from a high of 1.2% (1.1 to 1.3 95% highest posterior density interval or HDI) for shortbill spearfish to a low of 0.002% (0.001 to 0.003 95% HDI) for blue shark. Depredation of catch is a rare event in this fishery, occurring in about 6% of sets. When depredation did occur, most frequently odontocetes depredated a small proportion of the catch, however, there was large variability in depredation rates between teleost species. For example, bigeye tuna was two times more likely to be depredated than yellowfin tuna (odds ratio = 2.03, 95% CI: 1.8-2.3, P<0.0001). For sets with depredation, 10% and 2% of sets had depredation of over half of the captured bigeye tuna and combined teleosts, respectively. All elasmobranch species had relatively low depredation rates, where only 7 of almost 0.5M captured elasmobranchs were depredated. Odontocetes selectively depredate a subset of the teleost species captured within sets, possibly based on net energy value, chemical, visual, acoustic and textural characteristics and body size, but not median length, which was found to be unrelated to depredation rate (Pearson's r = 0.14, 95% CI: -0.26 to 0.50, p = 0.49). Study findings provide evidence to support the identification and innovation of effective and commercially viable methods to mitigate odontocete depredation and bycatch.

Moonlight-driven biological choruses in Hawaiian coral reefs

Sounds from fish and invertebrates in coral reefs can create persistent cacophonies that can be recorded for ecosystem monitoring, including during nighttime hours where visual surveys are typically not feasible. Here we use soundscape measurements in Hawaii to demonstrate that multiple coral reef communities are rapidly responsive to shifts in nighttime ambient light, with sustained changes in biological sound between moonrise and moonset. High frequency pulse train sounds from fish (0.5-1.5 kHz) are found to increase during moonlight hours, while low frequency fish vocalizations (0.1-0.3 kHz) and invertebrate sounds (2-20 kHz) are found to decrease during moonlight hours. These discoveries suggest that the rising and setting of the moon triggers regular shifts in coral reef ecosystem interactions. Future acoustic monitoring of reef health may be improved by comparing soundscapes during moonlight and non-moonlight hours, which may provide early indicators of shifts in the relative abundance of separate reef communities.

Subsurface temperature estimates from a Regional Ocean Modelling System (ROMS) reanalysis provide accurate coral heat stress indices across the Main Hawaiian Islands

As ocean temperatures continue to rise, coral bleaching events around the globe are becoming stronger and more frequent. High-resolution temperature data is therefore critical for monitoring reef conditions to identify indicators of heat stress. Satellite and in situ measurements have historically been relied upon to study the thermal tolerances of coral reefs, but these data are quite limited in their spatial and temporal coverage. Ocean circulation models could provide an alternative or complement to these limited data, but a thorough evaluation against in situ measurements has yet to be conducted in any Pacific Islands region. Here we compared subsurface temperature measurements around the nearshore Main Hawaiian Islands (MHI) from 2010 to 2017 with temperature predictions from an operational Regional Ocean Modeling System (ROMS) to evaluate the potential utility of this model as a tool for coral reef management. We found that overall, the ROMS reanalysis presents accurate subsurface temperature predictions across the nearshore MHI region and captures a significant amount of observed temperature variability. The model recreates several temperature metrics used to identify coral heat stress, including predicting the 2014 and 2015 bleaching events around Hawai'i during the summer and fall months of those years. The MHI ROMS simulation proves to be a useful tool for coral reef management in the absence of, or to supplement, subsurface and satellite measurements across Hawai'i and likely for other Pacific Island regions.

Racial and Ethnic Differences in Social Determinants of Health and Health-Related Social Needs Among Adults - Behavioral Risk Factor Surveillance System, United States, 2022

Social determinants of health (SDOH) are a broad array of social and contextual conditions where persons are born, live, learn, work, play, worship, and age that influence their physical and mental wellbeing and quality of life. Using 2022 Behavioral Risk Factor Surveillance System data, this study assessed measures of adverse SDOH and health-related social needs (HRSN) among U.S. adult populations. Measures included life satisfaction, social and emotional support, social isolation or loneliness, employment stability, food stability/security, housing stability/security, utility stability/security, transportation access, mental well-being, and health care access. Prevalence ratios were adjusted for age, sex, education, marital status, income, and self-rated health. Social isolation or loneliness (31.9%) and lack of social and emotional support (24.8%) were the most commonly reported measures, both of which were more prevalent among non-Hispanic (NH) American Indian or Alaska Native, NH Black or African American, NH Native Hawaiian or other Pacific Islander, NH multiracial, and Hispanic or Latino adults than among NH White adults. The majority of prevalence estimates for other adverse SDOH and HRSN were also higher across all other racial and ethnic groups (except for NH Asian) compared with NH White adults. SDOH and HRSN data can be used to monitor needed social and health resources in the U.S. population and help evaluate population-scale interventions.

Fluctibacter corallii gen. nov., sp. nov., isolated from the coral Montipora capitata on a reef in Kāne'ohe Bay, O'ahu, Hawai'i, reclassification of Aestuariibacter halophilus as Fluctibacter halophilus comb. nov., and Paraglaciecola oceanifecundans as a later heterotypic synonym of Paraglaciecola agarilytica

Strain AA17T was isolated from an apparently healthy fragment of Montipora capitata coral from the reef surrounding Moku o Lo'e in Kāne'ohe Bay, O'ahu, Hawai'i, USA, and was taxonomically evaluated using a polyphasic approach. Comparison of a partial 16S rRNA gene sequence found that strain AA17T shared the greatest similarity with Aestuariibacter halophilus JC2043T (96.6%), and phylogenies based on 16S rRNA gene sequences grouped strain AA17T with members of the Aliiglaciecola, Aestuariibacter, Lacimicrobium, Marisediminitalea, Planctobacterium, and Saliniradius genera. To more precisely infer the taxonomy of strain AA17T, a phylogenomic analysis was conducted and indicated that strain AA17T formed a monophyletic clade with A. halophilus JC2043T, divergent from Aestuariibacter salexigens JC2042T and other related genera. As a result of monophyly and multiple genomic metrics of genus demarcation, strain AA17T and A. halophilus JC2043T comprise a distinct genus for which the name Fluctibacter gen. nov. is proposed. Based on a polyphasic characterisation and identifying differences in genomic and taxonomic data, strain AA17T represents a novel species, for which the name Fluctibacter corallii sp. nov. is proposed. The type strain is AA17T (= LMG 32603 T = NCTC 14664T). This work also supports the reclassification of A. halophilus as Fluctibacter halophilus comb. nov., which is the type species of the Fluctibacter genus. Genomic analyses also support the reclassification of Paraglaciecola oceanifecundans as a later heterotypic synonym of Paraglaciecola agarilytica.

Unmet Reproductive Health Needs of Transgender and Gender Diverse People in Hawai'i: A Qualitative Needs Assessment

The purpose of this study was to assess the reproductive health experiences of transgender and gender diverse people in Hawai'i, identify reproductive health needs that were unmet, and explore opportunities for addressing those needs. This was a qualitative, semi-structured individual interview study. Adults who identified as transgender or gender diverse were interviewed about their experiences accessing reproductive health services, their needs, and their ideas about clinical settings in which to receive reproductive health care services. Interviews were conducted until thematic saturation was reached. Six trans men, 6 trans women, and 4 people who identified as non-binary or genderqueer were interviewed. Negative experiences in health care settings, particularly when seeking reproductive health care services, were common. Participants often had multiple providers and gender-affirming care was often accessed separately from other health care services. Desires for fertility and pregnancy varied widely between participants but were often not addressed at the initiation of gender-affirming care. Finding trans-friendly providers was notably difficult and participants often relied on friends and other members of the transgender community for guidance. Obstetrics and gynecology clinics present a potential opportunity for access to reproductive health services although their gendered environment was concerning for some participants. Transgender and gender diverse people in Hawai'i have access to some reproductive health services but experience stigma in certain settings. There is a need for ongoing improvement in reproductive health care services in Hawai'i to improve access for transgender and gender nonconforming people in Hawai'i.

Perceived Value of a Women's Health Journal Club in Rural Hawai'i

OBJECTIVES

Rural Hawai'i faces a shortage of physicians specializing in women's health. Improving clinician collaboration and access to the scientific literature are potential strategies for improving physician retention in this community. In 2021, a monthly women's health journal club was established for local clinicians and trainees on Hawai'i Island. Although journal clubs are common in large academic institutions, there are limited data regarding the value of journal clubs in rural and community practices. This study aimed to evaluate the value of a women's health journal club on Hawai'i Island.

METHODS

We used an anonymous Web-based survey to evaluate the value of the journal club.

RESULTS

Of the 18 eligible clinicians participating in the women's health journal club, 13 completed a Web-based survey (response rate 72%). The common reasons for attending journal club included wanting to learn about research methods/statistics (100%), seeking opportunities to discuss current best practices (86%), and desiring to practice critical review skills (71%). The majority of respondents (77%) believed that journal club was a valuable activity, and 92% of respondents would recommend this activity to a colleague. This journal club allowed participants to improve their understanding of research methods (85%) and stay up-to-date with medical advancements (85%).

CONCLUSIONS

This community-based journal club is a valuable activity for clinicians practicing on Hawai'i Island. Other rural communities may similarly benefit from engaging in structured scholarly discussion.

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage

Importance

Private Medicare Advantage (MA) plans recently surpassed traditional Medicare (TM) in enrollment. However, MA plans are facing scrutiny for burdensome prior authorization and potential rationing of care, including home health. MA beneficiaries are less likely to receive home health, but recent evidence on differences in service intensity and outcomes among home health patients is lacking.

Objective

To examine differences in home health service intensity and patient outcomes between MA and TM.

Design, Setting, and Participants

This cross-sectional study was conducted from January 2019 to December 2022 in 102 home health locations in 19 states and included 178 195 TM and 107 102 MA patients 65 years or older with 2 or fewer 60-day home health episodes. It included a secondary analysis of standardized assessment and visit data. Inverse probability of treatment weighting regression compared service intensity and patient outcomes between MA and TM episodes, accounting for differences in demographic characteristics, medical complexity, functional and cognitive impairments, social environment, caregiver support, and local community factors. Models included office location, year, and reimbursement policy fixed effects. Data were analyzed between September 2023 and July 2024.

Exposure

TM vs MA plan.

Main Outcomes and Measures

Home health length of stay and number of visits from nursing, physical, occupational, and speech therapy, social work, and home health aides. Patient outcomes included improvement in self-care and mobility function, discharge to the community, and transfer to an inpatient facility during home health.

Results

Of 285 297 total patients, 180 283 (63.2%) were female; 586 (0.2%) were American Indian/Alaska Native, 8957 (3.1%) Asian, 28 694 (10.1%) Black, 7406 (2.6%) Hispanic, 1959 (0.7%) Native Hawaiian/Pacific Islander, 237 017 (83.1%) non-Hispanic White, and 678 (0.2%) multiracial individuals. MA patients had shorter home health length of stay by 1.62 days (95% CI, -1.82 to 1.42) and received fewer visits from all disciplines except social work. There were no differences in inpatient transfers. MA patients had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively (mobility odds ratio [OR], 0.97; 95% CI, 0.94-0.99; self-care OR, 0.96; 95% CI, 0.92-0.99). MA patients were 5% more likely to discharge to the community compared with TM (OR, 1.05; 95% CI, 1.01-1.08).

Conclusions and Relevance

The results of this cross-sectional study suggest that MA patients receive shorter and less intensive home health care vs TM patients with similar needs. Differences may be due to the administrative burden and cost-limiting incentives of MA plans. MA patients experienced slightly worse functional outcomes but were more likely to discharge to the community, which may have negative implications for MA patients, including reduced functional independence or increased caregiver burden.

Adaptation of a risk-based framework for evaluating indirect effects of dredging on sensitive habitats near federal navigation channels: An application of the framework to coral reefs at Honolulu Harbor, Hawai'i

In major harbors and ports in the United States and its territories, the US Army Corps of Engineers maintains federal navigation channels in proximity to coral reefs (e.g., Honolulu Harbor, HI; Miami Harbor, FL; Apra Harbor, Guam) and other sensitive habitats. To effectively predict potential adverse impacts from dredging activities near these sensitive habitats, a holistic approach to improve understanding of the pressures on these habitats is needed to foster a more complete prediction of risk drivers. To achieve this, risk-based frameworks that account for the full range of natural and anthropogenic impacts need to be adapted and applied specifically for assessing and managing indirect dredging impacts on sensitive environments. In this article, we address this need by incorporating a drivers-pressures-stressors-condition-response (DPSCR4 ) conceptual framework to broaden a comprehensive conceptual model of the coupled human-ecological system. To help understand these complex interactions, DPSCR4 was applied to evaluate dredging and other unrelated environmental pressures (e.g., terrestrial runoff) in a proof-of-concept dredging project in Honolulu Harbor, Hawai'i, USA, with a focus on the indirect effects of dredge plumes. Particle tracking models and risk-based tools were used to evaluate sediment resuspended during a hypothetical mechanical dredging activity near sensitive coral habitats. Stoplight indicators were developed to predict indirect sediment plume impacts on coral and then compared to exposure modeling results. The strengths and limitations of the approach are presented and the incorporation of the risk framework into environmental management decisions is discussed. Integr Environ Assess Manag 2024;20:547-561. Published 2023. This article is a U.S. Government work and is in the public domain in the USA.

Behavioural plasticity compensates for adaptive loss of cricket song

Behavioural flexibility might help animals cope with costs of genetic variants under selection, promoting genetic adaptation. However, it has proven challenging to experimentally link behavioural flexibility to the predicted compensation of population-level fitness. We tested this prediction using the field cricket Teleogryllus oceanicus. In Hawaiian populations, a mutation silences males and protects against eavesdropping parasitoids. To examine how the loss of this critical acoustic communication signal impacts offspring production and mate location, we developed a high-resolution, individual-based tracking system for low-light, naturalistic conditions. Offspring production did not differ significantly in replicate silent versus singing populations, and fitness compensation in silent conditions was associated with significantly increased locomotion in both sexes. Our results provide evidence that flexible behaviour can promote genetic adaptation via compensation in reproductive output and suggest that rapid evolution of animal communication systems may be less constrained than previously appreciated.

Development of Youth-Centered Health Messaging Posters for High School-Based Health Clinics in Hawaii

BACKGROUND

Youth may be reluctant to seek health care from school health providers due to feeling embarrassed or stigmatized in the health office environment or worried about their confidentiality. The purpose of this project was to create a set of youth-centered health posters that promote youth engagement with nursing staff and to standardize health messaging across high schools in Hawaii school-based clinics.

METHODS

Two community advisory boards, 1 composed of 10 youth stakeholders (mean age 17 years) and the other of 7 adult stakeholders, informed poster development utilizing web-based discussion groups. The discussions were transcribed, and additional data was collected using field notes and anonymous digital messages. Adult advisory board members also provided feedback on suggested poster text through an online survey.

RESULTS

Youth and adult advisory board participants identified 4 key health concerns facing youth: confidentiality, sexual health, relationships, and mental health. Based on input from the 2 advisory boards, 4 posters were developed, each centered on 1 key health issue.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

School-based posters can convey important messages to help youth understand their health care rights and responsibilities, as well as identify important issues open for discussion with nurses.

CONCLUSION

Posters are an underutilized tool for school health providers to create welcoming, inclusive health care environments and facilitate health-related conversations with youth. This paper describes participant feedback about the characteristics of a memorable poster and briefly outlines current knowledge and recommendations for school health providers regarding each of the 4 health issues.

Barriers to Alzheimer Disease Clinical Trial Participation in a Minority Population

BACKGROUND

Alzheimer disease (AD), the most common neurodegenerative disorder in the United States, disproportionately burdens minority populations.

OBJECTIVE

To explore barriers to AD clinical trial participation by Asian and Native Hawaiian patients diagnosed with AD or mild cognitive impairment.

METHOD

We surveyed 187 patients with a Mini-Mental State Examination score ≥14 between January 2022 and June 2022. The score cutoff for clinical trial eligibility was set by the institution. Individuals also completed a 15-question telephone survey that assessed demographics, barriers to clinical trial participation, and clinical trial improvement methods.

RESULTS

Forty-nine patients responded, with a response rate of 26%. Asian and Native Hawaiian patients were less likely than White patients to participate in AD trials. The main barrier to participation was a lack of information about AD trials. Providing additional information regarding AD trials to patients and family members were listed as the top two reasons patients would consider participating in a clinical trial.

CONCLUSION

Insufficient information about AD clinical trials is the primary barrier to participation among Asian and Native Hawaiian patients, followed by difficulty coordinating transportation and, in the case of Asians, the time required for clinical trials. Increased outreach, education, and assistance with logistics in these populations should be pursued to improve rates of participation in clinical trials.

Mesophotic corals in Hawai'i maintain autotrophy to survive low-light conditions

In mesophotic coral ecosystems, reef-building corals and their photosynthetic symbionts can survive with less than 1% of surface irradiance. How depth-specialist corals rely upon autotrophically and heterotrophically derived energy sources across the mesophotic zone remains unclear. We analysed the stable carbon (δ13C) and nitrogen (δ15N) isotope values of a Leptoseris community from the 'Au'au Channel, Maui, Hawai'i (65-125 m) including four coral host species living symbiotically with three algal haplotypes. We characterized the isotope values of hosts and symbionts across species and depth to compare trophic strategies. Symbiont δ13C was consistently 0.5‰ higher than host δ13C at all depths. Mean colony host and symbiont δ15N differed by up to 3.7‰ at shallow depths and converged at deeper depths. These results suggest that both heterotrophy and autotrophy remained integral to colony survival across depth. The increasing similarity between host and symbiont δ15N at deeper depths suggests that nitrogen is more efficiently shared between mesophotic coral hosts and their algal symbionts to sustain autotrophy. Isotopic trends across depth did not generally vary by host species or algal haplotype, suggesting that photosynthesis remains essential to Leptoseris survival and growth despite low light availability in the mesophotic zone.

Reduction of genetic diversity in 'Alalā (Hawaiian crow; Corvus hawaiiensis) between the late 1800s and the late 1900s

Genetic and genomic data are increasingly used to aid conservation management of endangered species by providing insights into evolutionary histories, factors associated with extinction risks, and potential for future adaptation. For the 'Alalā, or Hawaiian crow (Corvus hawaiiensis), genetic concerns include negative correlations between inbreeding and hatching success. However, it is unclear if low genetic diversity and inbreeding depression are consequences of a historical population bottleneck, or if 'Alalā had historically low genetic diversity that predated human influence, perhaps as a result of earlier declines or founding events. In this study, we applied a hybridization-based sequence capture to generate a genome-wide single nucleotide polymorphism (SNP) dataset for comparing historical specimens collected in the 1890s, when 'Alalā were more numerous, to samples taken between 1973 and 1998, when 'Alalā population densities were near the lowest documented levels in the wild, prior to all individuals being collected for captive rearing. We found low genome-wide diversity in both sample groups, however, the modern sample group (1973 to 1998 cohort) exhibited relatively fewer polymorphic alleles, a lower proportion of polymorphic loci, and lower observed heterozygosity, consistent with a population decline and potential bottleneck effects. These results combined with a current low population size highlight the importance of continued efforts by conservation managers to mitigate inbreeding and maintain founder representation to preserve what genetic diversity remains.

Organellar genomic characterization of Anunuuluaehu liula representing a new genus and species of Phyllophoraceae (Gigartinales, Rhodophyta) from the mesophotic zone of Hawai'i

Over the last 2 decades, routine collections in the Hawaiian Archipelago have expanded to mesophotic reefs, leading to the discovery of a new red algal genus and species, here described as Anunuuluaehu liula gen. et sp. nov. This study provides a detailed genus and species description and characterizes chloroplast and mitochondrial organellar genomes. The new genus, Anunuuluaehu, shares many characteristics with the family Phyllophoraceae and shows close similarities to Archestennogramma and Stenogramma, including habit morphology, nemathecia forming proliferations at the outer cortex with terminal chains of tetrasporangia, and carposporophytes with multi-layered pericarps. The single species in this genus exhibits distinctive features within the Phyllophoraceae: the presence of single-layer construction of large medullary cells and the development of long, tubular gonimoblastic filaments. Multi-gene phylogenetic analyses confirmed it as a unique, monophyletic lineage within the family. Cis-splicing genes, interrupted by intron-encoded proteins within group II introns, are present in both the chloroplast and mitochondrial genomes of A. liula. Notably, a specific region of the coxI group II intron exhibits similarity to fungal introns. Anunuuluaehu liula is presumed to be endemic to the Hawaiian Archipelago and thus far is known to live solely at mesophotic depths from Hōlanikū to Kaho'olawe ranging from 54 to 201 m, which is the deepest collection record of any representative in the family. Overall, this study enhances our understanding of the genomic and taxonomic complexities of red algae in mesophotic habitats, emphasizing the significance of continued research in this area to uncover further insights into evolutionary processes and biogeographic patterns.

Risk of contralateral breast cancer among Asian/Pacific Islander women in the United States

PURPOSE

While breast cancer studies often aggregate Asian/Pacific Islander (API) women, as a single group or exclude them, this population is heterogeneous in terms of genetic background, environmental exposures, and health-related behaviors, potentially resulting in different cancer outcomes. Our purpose was to evaluate risks of contralateral breast cancer (CBC) among subgroups of API women with breast cancer.

METHODS

We conducted a retrospective cohort study of women ages 18 + years diagnosed with stage I-III breast cancer between 2000 and 2016 in the Surveillance, Epidemiology and End Results registries. API subgroups included Chinese, Japanese, Filipina, Native Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other API women. Asynchronous CBC was defined as breast cancer diagnosed in the opposite breast 12 + months after first primary unilateral breast cancer. Multivariable-adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups.

RESULTS

From a cohort of 44,362 API women with breast cancer, 25% were Filipina, 18% were Chinese, 14% were Japanese, and 8% were Indian/Pakistani. API women as an aggregate group had increased risk of CBC (SHR 1.15, 95% CI 1.08-1.22) compared to NHW women, among whom Chinese (SHR 1.23, 95% CI 1.08-1.40), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Native Hawaiian (SHR 1.69, 95% CI 1.37-2.08) women had greater risks.

CONCLUSION

Aggregating or excluding API patients from breast cancer studies ignores their heterogeneous health outcomes. To advance cancer health equity among API women, future research should examine inequities within the API population to design interventions that can adequately address their unique differences.

Atypical jobs series: An interview with Dr. Julie Takishima-Lacasa

This article outlines the early career of Dr. Takishima-Lacasa as a commuting clinical psychologist in the island state of Hawai'i. This work setting is made atypical by the necessity to fly between different islands within the state and provide services to rural communities. Dr. Takishima-Lacasa discusses her motivation behind her decision to become a clinical psychologist and her time working on the islands. She addresses challenging aspects of being a rural provider, how she worked to overcome those obstacles, and the rewards to working in rural communities. She provides information to those looking to increase their cultural knowledge and offers advice to those interested in working with rural communities or underserved populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Improving Interprofessional Collaboration Between Social Work and Pharmacy Through Hybrid and Virtual Learning Experiences

The professions of pharmacy and social work are not generally assumed to directly collaborate in patient care; however, these professions are complementary. Health and wellbeing outcomes are significantly improved when care is managed by an interprofessional team that communicates and collaborates to ensure all aspects of care are effectively managed. The creation of educational opportunities for students to practice working together provides enhanced educational experiences and leads to their success as professionals. Pharmacy and social work faculty developed an interprofessional education activity specifically aimed at integrative student learning. Faculty and students based on various islands throughout the state of Hawai'i and the US territory of Guam participated in the experience. The case study encouraged interprofessional teamwork and collaboration. The case study also challenged students to share profession-specific knowledge with each other. Mean evaluation scores were compared between hybrid and fully online platforms. Evaluation scores were high and at least as good or higher in the fully online exercise compared to the hybrid exercises. Using the 20-item pre-post format, Interprofessional Collaborative Competencies Attainment Survey, results indicated statistically significant improvements in scores for all questions and domains (all P<.001). When hybrid training and fully online training were compared, there were no significant differences in pre scores, but post domain scores were significantly higher in students who experienced fully online training. This interprofessional case-based activity successfully promoted interprofessional learning and collaboration. Introducing learners to this type of collaborative practice while in school is critical for future collaboration in the workforce.

Application of films developed with tilapia gelatin (Oreochromis niloticus), added with pitomba plant extract (Talisia esculenta) in Hawaii papaya

In the present study, a film based on the gelatin skin of tilapia (Oreochromis niloticus) was developed, using surfactants and adding plant extract of pitomba seed (Talisia esculenta). The aim was to investigate the mechanical and barrier properties of the cover, as well as its effectiveness in conserving papayas against diseases caused by fungi. The film presented tensile strength of 38.78 MPa, elongation of 120.49%, and water vapor permeability of 5.90 g.mm.h-1.m2.kPa-1 when equally composed of SDS and Tween 80, in a percentage of 40% in relation to the total mass of the film. The films lasted 12 d in an environment with a relative humidity of 75% (25 ºC), longer than the shelf life of papaya (limited to 8 d). With applying the film with the extract, the incidence of diseases such as anthracnose, fusariosis, and stem rot caused by these microorganisms in papaya was reduced.

Improving the prediction of wildfire susceptibility on Hawai'i Island, Hawai'i, using explainable hybrid machine learning models

This study presents a comparative analysis of four Machine Learning (ML) models used to map wildfire susceptibility on Hawai'i Island, Hawai'i. Extreme Gradient Boosting (XGBoost) combined with three meta-heuristic algorithms - Whale Optimization (WOA), Black Widow Optimization (BWO), and Butterfly Optimization (BOA) - were employed to map areas susceptible to wildfire. To generate a wildfire inventory, 1408 wildfire points were identified within the study area from 2004 to 2022. The four ML models (XGBoost, WOA-XGBoost, BWO-XGBoost, and BOA-XGBoost) were run using 14 wildfire-conditioning factors categorized into four main groups: topographical, meteorological, vegetation, and anthropogenic. Six performance metrics - sensitivity, specificity, positive predictive values, negative predictive values, the Area Under the receiver operating characteristic Curve (AUC), and the average precision (AP) of Precision-Recall Curves (PRCs) - were used to compare the predictive performance of the ML models. The SHapley Additive exPlanations (SHAP) framework was also used to interpret the importance values of the 14 influential variables for the modeling of wildfire on Hawai'i Island using the four models. The results of the wildfire modeling indicated that all four models performed well, with the BWO-XGBoost model exhibiting a slightly higher prediction performance (AUC = 0.9269), followed by WOA-XGBoost (AUC = 0.9253), BOA-XGBoost (AUC = 0.9232), and XGBoost (AUC = 0.9164). SHAP analysis revealed that the distance from a road, annual temperature, and elevation were the most influential factors. The wildfire susceptibility maps generated in this study can be used by local authorities for wildfire management and fire suppression activity.

Amphistomy increases leaf photosynthesis more in coastal than montane plants of Hawaiian 'ilima (Sida fallax)

PREMISE

The adaptive significance of amphistomy (stomata on both upper and lower leaf surfaces) is unresolved. A widespread association between amphistomy and open, sunny habitats suggests the adaptive benefit of amphistomy may be greatest in these contexts, but this hypothesis has not been tested experimentally. Understanding amphistomy informs its potential as a target for crop improvement and paleoenvironment reconstruction.

METHODS

We developed a method to quantify "amphistomy advantage" (AA $\text{AA}$ ) as the log-ratio of photosynthesis in an amphistomatous leaf to that of the same leaf but with gas exchange blocked through the upper surface (pseudohypostomy). Humidity modulated stomatal conductance and thus enabled comparing photosynthesis at the same total stomatal conductance. We estimatedAA $\text{AA}$ and leaf traits in six coastal (open, sunny) and six montane (closed, shaded) populations of the indigenous Hawaiian species 'ilima (Sida fallax).

RESULTS

Coastal 'ilima leaves benefit 4.04 times more from amphistomy than montane leaves. Evidence was equivocal with respect to two hypotheses: (1) that coastal leaves benefit more because they are thicker and have lower CO2 conductance through the internal airspace and (2) that they benefit more because they have similar conductance on each surface, as opposed to most conductance being through the lower surface.

CONCLUSIONS

This is the first direct experimental evidence that amphistomy increases photosynthesis, consistent with the hypothesis that parallel pathways through upper and lower mesophyll increase CO2 supply to chloroplasts. The prevalence of amphistomatous leaves in open, sunny habitats can partially be explained by the increased benefit of amphistomy in "sun" leaves, but the mechanistic basis remains uncertain.

The military gear microbiome: risk factors surrounding the warfighter

Combat extremity wounds are highly susceptible to contamination from surrounding environmental material. This bioburden could be partially transferred from materials in immediate proximity to the wound, including fragments of the uniform and gear. However, the assessment of the microbial bioburden present on military gear during operational conditions of deployment or training is relatively unexplored. Opportunistic pathogens that can survive on gear represent risk factors for infection following injury, especially following combat blasts, where fibers and other materials are embedded in wounded tissue. We utilized 16S rRNA sequencing to assess the microbiome composition of different military gear types (boot, trouser, coat, and canteen) from two operational environments (training in Hawai'i and deployed in Indonesia) across time (days 0 and 14). We found that microbiome diversity, stability, and composition were dependent on gear type, training location, and sampling timepoint. At day 14, species diversity was significantly higher in Hawai'i samples compared to Indonesia samples for boot, coat, and trouser swabs. In addition, we observed the presence of potential microbial risk factors, as opportunistic pathogenic species, such as Acinetobacter, Pseudomonas, and Staphylococcus, were found to be present in all sample types and in both study sites. These study outcomes will be used to guide the design of antimicrobial materials and uniforms and for infection control efforts following combat blasts and other injuries, thereby improving treatment guidance during military training and deployment.IMPORTANCECombat extremity wounds are vulnerable to contamination from environments of proximity to the warfighter, leading to potential detrimental outcomes such as infection and delayed wound healing. Therefore, microbial surveillance of such environments is necessary to aid the advancement of military safety and preparedness through clinical diagnostics, treatment protocols, and uniform material design.

Transcriptional pathways across colony biofilm models in the symbiont Vibrio fischeri

Beneficial microbial symbionts that are horizontally acquired by their animal hosts undergo a lifestyle transition from free-living in the environment to associating with host tissues. In the model symbiosis between the Hawaiian bobtail squid and its microbial symbiont Vibrio fischeri, one mechanism used to make this transition during host colonization is the formation of biofilm-like aggregates in host mucosa. Previous work identified factors that are sufficient to induce V. fischeri biofilm formation, yet much remains unknown regarding the breadth of target genes induced by these factors. Here, we probed two widely used in vitro models of biofilm formation to identify novel regulatory pathways in the squid symbiont V. fischeri ES114. We discovered a shared set of 232 genes that demonstrated similar patterns in expression in both models. These genes comprise multiple exopolysaccharide loci that are upregulated and flagellar motility genes that are downregulated, with a consistent decrease in measured swimming motility. Furthermore, we identified genes regulated downstream of the key sensor kinase RscS that are induced independent of the response regulator SypG. Our data suggest that transcriptional regulator VpsR plays a strong role in expression of at least a subset of these genes. Overall, this study adds to our understanding of the genes involved in V. fischeri biofilm regulation while revealing new regulatory pathways branching from previously characterized signaling networks.IMPORTANCEThe V. fischeri-squid system provides an opportunity to study biofilm development both in the animal host and in culture-based biofilm models that capture key aspects of in vivo signaling. In this work, we report the results of the transcriptomic profiling of two V. fischeri biofilm models followed by phenotypic validation and examination of novel signaling pathway architecture. Remarkable consistency between the models provides a strong basis for future studies using either approach or both. A subset of the factors identified by the approaches were validated in the work, and the body of transcriptomic data provides a number of leads for future studies in culture and during animal colonization.

Rapid sexual signal diversification is facilitated by permissive females

The initial process by which novel sexual signals evolve remains unclear, because rare new variants are susceptible to loss by drift or counterselection imposed by prevailing female preferences.1,2,3,4 We describe the diversification of an acoustic male courtship signal in Hawaiian populations of the field cricket Teleogryllus oceanicus, which was brought about by the evolution of a brachypterous wing morph ("small-wing") only 6 years ago.5 Small-wing has a genetic basis and causes silence or reduced-amplitude signaling by miniaturizing male forewings, conferring protection against an eavesdropping parasitoid, Ormia ochracea.5 We found that wing reduction notably increases the fundamental frequency of courtship song from an average of 5.1 kHz to 6.4 kHz. It also de-canalizes male song, broadening the range of peak signal frequencies well outside normal song character space. As courtship song prompts female mounting and is sexually selected,6,7,8,9 we evaluated two scenarios to test the fate of these new signal values. Females might show reduced acceptance of small-wing males, imposing counterselection via prevailing preferences. Alternatively, females might accept small-wing males as readily as long-wing males if their window of preference is sufficiently wide. Our results support the latter. Females preferred males who produced some signal over none, but they mounted sound-producing small-wing males as often as sound-producing long-wing males. Indiscriminate mating can facilitate the persistence of rare, novel signal values. If female permissiveness is a general characteristic of the earliest stages of sexual signal evolution, then taxa with low female mate acceptance thresholds should be more prone to diversification via sexual selection.

A macroplastic vulnerability index for marine mammals, seabirds, and sea turtles in Hawai'i

Plastic pollution is having devastating consequences for marine organisms across the planet. However, the population level effects of macroplastic pollution remain difficult and costly to quantify. As a result, there is a need for alternative approaches to evaluate species risk to plastic pollution and inform management needs. We apply a trait-based framework for macroplastic pollution to develop a relative vulnerability index-informed by three dimensions: likelihood of exposure, species' sensitivity, and population resilience-for marine mammals, seabirds, and sea turtles found in Hawai'i. This index ranks 63 study species based on their population level vulnerability to macroplastic pollution, with the highest scoring species being the most vulnerable. Our results indicate that ducks, waders, and noddies with large populations were the least vulnerable to macroplastics, while the most vulnerable were the Hawaiian monk seal, sea turtles, baleen whales, and some albatross and petrel species. This index can inform species in need of population monitoring in Hawai'i, and direct other management priorities (e.g., locations for clean-ups or booms). More broadly, this work exemplifies the value of qualitative risk assessment approaches for better understanding the population level effects of macroplastic pollution and showcases how vulnerability indices can be used to inform management priorities.

Gene modelling and annotation for the Hawaiian bobtail squid, Euprymna scolopes

Coleoid cephalopods possess numerous complex, species-specific morphological and behavioural adaptations, e.g., a uniquely structured nervous system that is the largest among the invertebrates. The Hawaiian bobtail squid (Euprymna scolopes) is one of the most established cephalopod species. With its recent publication of the chromosomal-scale genome assembly and regulatory genomic data, it also emerges as a key model for cephalopod gene regulation and evolution. However, the latest genome assembly has been lacking a native gene model set. Our manuscript describes the generation of new long-read transcriptomic data and, made using this combined with a plethora of publicly available transcriptomic and protein sequence data, a new reference annotation for E. scolopes.

Environmental and geographical factors influence the occurrence and abundance of the southern house mosquito, Culex quinquefasciatus, in Hawai'i

Hawaiian honeycreepers, a group of endemic Hawaiian forest birds, are being threatened by avian malaria, a non-native disease that is driving honeycreepers populations to extinction. Avian malaria is caused by the parasite Plasmodium relictum, which is transmitted by the invasive mosquito Culex quinquefasciatus. Environmental and geographical factors play an important role in shaping mosquito-borne disease transmission dynamics through their influence on the distribution and abundance of mosquitoes. We assessed the effects of environmental (temperature, precipitation), geographic (site, elevation, distance to anthropogenic features), and trap type (CDC light trap, CDC gravid trap) factors on mosquito occurrence and abundance. Occurrence was analyzed using classification and regression tree models (CART) and generalized linear models (GLM); abundance (count data) was analyzed using generalized linear mixed models (GLMMs). Models predicted highest mosquito occurrence at mid-elevation sites and between July and November. Occurrence increased with temperature and precipitation up to 580 mm. For abundance, the best model was a zero-inflated negative-binomial model that indicated higher abundance of mosquitoes at mid-elevation sites and peak abundance between August and October. Estimation of occurrence and abundance as well as understanding the factors that influence them are key for mosquito control, which may reduce the risk of forest bird extinction.

"Community 101 for researchers": an online training program to build capacity for ethical community-engaged research with Native Hawaiians and Pacific Islanders

To address the history of unethical research and community distrust in research among Native Hawaiian and Pacific Islander communities, we developed the "Community 101 for Researchers" training program, which was launched in 2014 to enhance the capacity of researchers to engage in ethical community-engaged research. The purpose of this paper is to describe the development of this training program as well as its reach and feedback from participants. The Community 101 training program is a self-paced, 2-h online training program featuring community-engaged researchers from the University of Hawai'i and their longstanding community partners. Throughout the five modules, we highlight the historical context of Native Hawaiians and Pacific Islander populations in Hawai'i related to research ethics and use examples from the community as well as our own research projects that integrate community ethics, relevance, benefits, and input. To determine reach and gather participant feedback on the training, we extracted data from the user accounts. The training has been completed by 697 users to-date since its launch. Despite very little advertisement, an average of nearly 70 users have completed the Community 101 Program each year. The majority of the participants were located in Hawai'i though participants were also from other states and territories in the US, and international locations. The majority of participants were from universities in Hawai'i in 51 different departments demonstrating multidisciplinary relevance of the program's training. The general feedback from the 96 participants who completed an optional anonymous evaluation survey given at the end of the training was positive. The "Community 101 for Researchers" Training program is an accessible and relevant tool that can be used to advance ethical community engaged research, specifically with Native Hawaiian and Pacific Islander communities.

Trends in suicide mortality among prostate cancer survivors in the United States, 1975-2019

BACKGROUND

Suicide was an important cause of death in prostate cancer. This study intended to investigate trends in suicide mortality among prostate cancer (PCa) survivors from 1975 to 2019 in the United States.

METHOD

We identified PCa survivors from the Surveillance, Epidemiology, and End Results (SEER) program from January 1975 to December 2019. Standardized mortality rate (SMR) was calculated d to assess the relative risk of suicide in PCa survivors compared with the general men population. Poisson regression model was performed to test for trend of SMRs. The cumulative mortality rate of suicide was calculated to assess the clinical burden of suicide mortality.

RESULTS

7108 (0.2%) cases were death from suicide cause, and 2,308,923(65.04%%) cases recorded as dying from non-suicidal causes. Overall, a slightly higher suicide mortality rate among PCa survivors was observed compared with general male population (SMR: 1.15, 95%CI: 1.09-1.2). The suicide mortality rate declined significantly relative to the general population by the calendar year of diagnosis, from an SMR of 1.74(95%CI: 1.17-2.51) in 1975-1979 to 0.99(0.89-1.1) in 2015-2019 (Ptrend < 0.001). PCa survivors with aged over 84 years, black and other races, registered in registrations (including Utah, New Mexico, and Hawaii) failed to observe a decrease in suicide mortality (Ptrend > 0.05). The cumulative suicide mortality during 1975-1994 was distinctly higher than in 1995-2019(P < 0.001).

CONCLUSION

The trend in suicide mortality declined significantly from 1975 to 2019 among PCa survivors compared with the general male population in the United States. Notably, part of PCa survivors had no improvement in suicide mortality, and additional studies in the future were needed to explore it.

Leveraging the Hawai'i Nurse Residency Collaborative to Optimize Statewide Workforce Goals

This article describes the planning and implementation of the Hawai'i Nurse Residency Program (HNRP). The HNRP provides a shared, adaptable nurse residency program model. Through the HNRP, Hawai'i achieved high new-graduate retention and addressed other state initiatives. Since 2012, more than 1666 new-graduate nurses have participated, leading to an average 1st-year retention rate of 96.77%. Statewide nurse residency collaboratives are adaptable, may cost less than other alternatives, and may save on lost funds due to nurse attrition, resulting in an enhanced nursing workforce.

Forecasting marine spill risk along the U.S. Pacific coasts

This study analyzes historical trends and forecasts of spill risks in coastal counties along the U.S. Pacific, including Alaska and Hawaii. The method calculates spill impact, which rises with size but diminishes with age and distance from the coast. Over the past two decades, spill risks in California and Washington have increased significantly. Coastal counties in Puget Sound and San Francisco Bay have seen the highest increases, surpassing 2000 levels by 79 % and 39 %, respectively. Alaska experienced a moderate rise, while Oregon and Hawaii had smaller but noteworthy increases. Ocean currents may reduce risk by 38 % on average. Most counties are expected to experience increasing spill risks, particularly in Southern California and Southwest Washington, which could see nearly a 50 % increase by 2033 compared to present levels. These findings can help coastal zone monitoring and inform policies for protecting coastal regions, regulating marine transportation and reducing spill vulnerability.

The Moderating Role of Self-Rated Oral Health on the Association Between Oral Health Status and Subjective Well-Being: Findings From Chinese Older Adults in Hawai'i and Taiwan

This paper aims to address the research questions of whether individual's oral health status is associated with subjective well-being, as well as if there is possible moderating role of self-rated oral health among two groups of Chinese older adults (≥55 years old) in Honolulu, Hawai'i and Taichung, Taiwan. Using survey data collected in 2018 (N = 430, Honolulu) and in 2017 (N = 645, Taichung), ordinary least square regressions were applied. Results showed that, for both samples, oral health status was negatively and significantly associated with subjective well-being, and both associations were moderated by self-rated oral health. In addition, the moderating effects were more salient for the Honolulu sample, who enjoyed higher levels of self-rated oral health and life satisfaction. These results suggest the significant associations of both oral health status and self-rated oral health on individual health and well-being for Chinese older adults residing in different cultural contexts.