Tuberculosis (TB) treatment is more challenging for patients with silicosis, as it complicates the diagnosis of both diseases and increases mortality risk. Silicosis, an incurable occupational disease, confounds the diagnosis of TB and vice versa, making it more difficult to accurately identify and treat either condition. Moreover, TB appears to accelerate the progression of silicosis. Exposure to silica dust, a common cause of silicosis, can also trigger latent TB to become active TB. This correspondence outlines a proposed framework for implementing collaborative TB-silicosis activities in India, aimed at improving early diagnosis and management for both diseases. An expert panel of medical professionals developed this framework through online consultations in October and November 2022. The panel\'s goal was to establish a consensus on integrating TB-silicosis activities, with a focus on early detection and proper management. The framework suggests testing all patients with silicosis for active TB and screening workers exposed to silica dust for latent TB infection. It also recommends that patients with TB who have a history of occupational exposure to silica dust should be tested for silicosis. Reliable diagnostic tools, such as chest X-rays, are emphasized, providing guidance on their use for both diseases. The proposed collaborative TB-silicosis framework offers a structured approach to identifying and managing these two diseases, contributing to the global goal of eliminating silicosis by 2030 and aligning with the World Health Organization\'s targets for reducing TB incidence and mortality. It recommends specific strategies for implementation, including testing, referral systems, and workplace-based interventions. The framework also underscores the need for coordinated efforts among stakeholders, including the ministries of health, labor, industry, and environment. This correspondence provides valuable insights into how India can successfully implement collaborative TB-silicosis activities, serving as a model for other regions with similar challenges.

The COVID-19 pandemic revealed that data sharing challenges persist across public health information systems. We examine the specific challenges in sharing syndromic surveillance data between state, local, and federal partners. These challenges are complicated by US federalism, which decentralizes public health response and creates friction between different government units. The current policies restrict federal access to state and local syndromic surveillance data without each jurisdiction\'s consent. These policies frustrate legitimate federal governmental interests and are contrary to ethical guidelines for public health data sharing. Nevertheless, state and local public health agencies must continue to play a central role as there are important risks in interpreting syndromic surveillance data without understanding local contexts. Policies establishing a collaborative framework will be needed to support data sharing between federal, state, and local partners. A collaborative framework would be enhanced by a governance group with robust state and local involvement and policy guardrails to ensure the use of data is appropriate. These policy and relational challenges must be addressed to actualize a truly national public health information system.

Reproducibility and replicability play a pivotal role in science. The article reflects on reproducibility and replicability as they figure in large scale genome-wide association studies. Overall, we emphasize the importance of enhancing data reproducibility, analysis reproducibility, and result replicability. We make recommendations pertaining to the development of study designs that address 1) batch effects and selection bias, 2) the incorporation of discrete discovery and replication phases, and 3) the procurement of a large sample size. We emphasize the importance of systematic and transparent data generation, processing, and quality control pipelines, as well as a rigorous field-specific standardized analysis protocol, We offer guidance with respect to collaborative frameworks, open access analysis tools, and software, and the use of supporting mandates, infrastructure, and repositories for data and resource sharing. Finally, we identify the role of incentives and culture in fueling the production of reproducible and replicable research through partnerships of researchers, funding agencies, and journals.

Modeling and predicting forest landscape dynamics are crucial for forest management and policy making, especially under the context of climate change and increased severities of disturbances. As forest landscapes change rapidly due to a variety of anthropogenic and natural factors, accurately and efficiently predicting forest dynamics requires the collaboration and synthesis of domain knowledge and experience from geographically dispersed experts. Owing to advanced web techniques, such collaboration can now be achieved to a certain extent, for example, discussion about modeling methods, consultation for model use, and surveying for stakeholders\' feedback can be conducted on the web. However, a research gap remains in terms of how to facilitate online joint actions in the core task of forest landscape modeling by overcoming the challenges from decentralized and heterogeneous data, offline model computation modes, complex simulation scenarios, and exploratory modeling processes. Therefore, we propose an online collaborative strategy to enable collaborative forest landscape dynamic prediction with four core modules, namely data preparation, forest landscape model (FLM) computation, simulation scenario configuration, and process organization. These four modules are designed to support: (1) voluntary data collection and online processing, (2) online synchronous use of FLMs, (3) collaborative simulation scenario design, altering, and execution, and (4) participatory modeling process customization and coordination. We used the LANDIS-II model as a representative FLM to demonstrate the online collaborative strategy for predicting the dynamics of forest aboveground biomass. The results showed that the online collaboration strategy effectively promoted forest landscape dynamic prediction in data preparation, scenario configuration, and task arrangement, thus supporting forest-related decision making.

BACKGROUND: India reports the highest number of tuberculosis (TB) and second-highest number of the human immunodeficiency virus (HIV) globally. We hypothesize that HIV might increase the existing financial burden of care among patients with TB. We conducted this study to estimate the costs incurred by patients with TB co-infected with HIV and to explore the perspectives of patients as well as program functionaries for reducing the costs.
METHODS: We conducted a descriptive cross-sectional study among 234 co-infected TB-HIV patients notified in the Bhavnagar region of western India from 2017 to 2020 to estimate the costs incurred, followed by in-depth interviews among program functionaries and patients to explore the solutions for reducing the costs. Costs were estimated in Indian rupees (INR) and expressed as median (interquartile range IQR). The World Health Organization defines catastrophic costs as when the total costs incurred by patients exceed 20% of annual household income. The in-depth interviews were audio-recorded, transcribed, and analyzed as codes grouped into categories.
RESULTS: Among the 234 TB-HIV co-infected patients, 78% were male, 18% were sole earners in the family, and their median (IQR) monthly family income was INR 9000 (7500-11,000) [~US$ 132 (110-162)]. The total median (IQR) costs incurred for TB were INR 4613 (2541-7429) [~US$ 69 (37-109)], which increased to INR 7355 (4337-11,657) [~US$ 108 (64-171)] on adding the costs due to HIV. The catastrophic costs at a 20% cut-off of annual household income for TB were 4% (95% CI 2-8%), which increased to 12% (95% CI 8-16%) on adding the costs due to HIV. Strengthening health systems, cash benefits, reducing costs through timely referral, awareness generation, and improvements in caregiving were some of the solutions provided by program functionaries and the patients.
CONCLUSIONS: We conclude that catastrophic costs due to TB-HIV co-infection were higher than that due to TB alone in our study setting. Bringing care closer to the patients would reduce their costs. Strengthening town-level healthcare facilities for diagnostics as well as treatment might shift the healthcare-seeking of patients from the private sector towards the government and thereby reduce the costs incurred.

The coronavirus disease-19 (COVID-19) pandemic promises to have lasting impacts on cancer clinical trials that could lead to faster patient access to new treatments. In this article, an international panel of oncology experts discusses the lasting impacts of the pandemic on oncology clinical trials and proposes solutions for clinical trial stakeholders, with the support of recent data on worldwide clinical trials collected by IQVIA. These lasting impacts and proposed solutions encompass three topic areas. Firstly, acceleration and implementation of new operational approaches to oncology trials with patient-centric, fully decentralized virtual approaches that include remote assessments via telemedicine and remote devices. Geographical differences in the uptake of remote technology, including telemedicine, are discussed in the article, focusing on the impact of the local adoption of new operational approaches. Secondly, innovative clinical trials. The pandemic has highlighted the need for new trial designs that accelerate research and limit risks and burden for patients while driving optimization of clinical trial objectives and endpoints, while testing is being minimized. Areas of considerations for clinical trial stakeholders are discussed in detail. In addition, the COVID-19 pandemic has exposed the underrepresentation of minority groups in clinical trials; the approach for oncology clinical trials to improve generalizability of efficacy and outcomes data is discussed. Thirdly, a new problem-focused collaborative framework between oncology trial stakeholders, including decision makers, to leverage and further accelerate the innovative approaches in clinical research developed during the COVID-19 pandemic. This could shorten timelines for patient access to new treatments by addressing the cultural and technological barriers to adopting new operational approaches and innovative clinical trials. The role of the different stakeholders is described, with the aim of making COVID-19 a catalyst for positive change in oncology clinical research and eventually in cancer care.

OBJECTIVE: The future of the nursing profession in Rwanda in large part depends on the students who join the workforce and the education they have received. Preparing students with the necessary knowledge, values and judgement requires practice settings to be learner-centered. This study aimed at exploring strategies that might improve the current practice-based learning environment.
METHODS: A focused ethnographic approach was used.
METHODS: Nursing students, staff nurses, clinical instructors and nurse leaders from three hospitals and an educational program participated in individual interviews.
RESULTS: Five key areas of improvement emanated from study data: 1) strengthening institutional support; 2) improving school-hospital collaboration; 3) building the capacity of nurses and clinical instructors; 4) restructuring clinical placement; and 5) reviewing the current supervision model. Based on these findings a \"Co-CREATES\" framework grounded in the actions of collaboration, care, recognizing, empowering, actively engaging, transforming, enhancement and support was developed. The framework offers a collaborative approach that engages every stakeholder in \"cocreating\" conditions that build positive practice environments which are conducive to preparing students as professional nurses.
CONCLUSIONS: The positive outcomes stemming from such a collaborative approach can further enhance a positive culture of collaboration in nursing education and practice.

To describe the collaborative framework used by National Institute of Nursing Research (NINR) investigators to advance symptom science and to provide a research exemplar.
The National Institutes of Health (NIH) Symptom Science Model (SSM) was developed to guide symptom science researchers to understand the molecular underpinnings of symptoms using innovative \"omics\" approaches. The process begins with a review of the literature to understand the state of the science of the symptoms of interest and is followed by cross-sectional, case-controlled, or longitudinal studies to identify potential biological correlates of these symptoms. The final steps include validation of these potential symptom biomarkers using multidisciplinary, collaborative, preclinical experiments, and proof-of-concept clinical trials.
Using the NIH SSM as a guide, the identification of biologic correlates of symptoms using omics and bioinformatic strategies depends on determining the distinct phenotype of the symptoms of interest. The identified biologic correlates of these symptoms are then validated for their functional relevance using in vitro and ex vivo experiments, or through proof-of-concept clinical trials. NINR investigators observed that activation of specific receptors in neural networks can trigger inflammation-related fatigue development and predispose patients to develop chronicity of symptoms. Specifically targeting these neural receptors can reduce symptom intensity.
Through using the NIH SSM as a guide, NINR investigators quickly generate data and discoveries that significantly advance symptom science by simultaneously collaborating with multiple experts and core laboratories to identify more correlates and validate their functional relevance in order to further understand the biological underpinnings of the symptoms of interest.
The collaborative framework used by NINR investigators as guided by the NIH SSM identifies functionally relevant clinical markers that can explain the biological underpinnings of symptoms and can be targeted to optimize symptom management.

Research involving secondary transition practices indicates a growing implementation of interagency collaboration to maximize service delivery to support students transitioning from school to adult life. Centers for Independent Living (CILs) are often excluded from collaborative partnerships and denied the opportunity to contribute as a valued stakeholder in the transition process.
A total of 189 CIL professionals representing represented 38 states completed the online survey to (a) identify to what degree does the factor structure of Thompson\'s Collaboration Survey holds for CIL professionals and (b) explore what specific CIL professional and agency characteristics predict greater collaboration between CILs and local education agencies (LEAs). Additionally (c) researchers sought to determine the degrees to which greater self-reported collaboration predicts more frequent transition services provided to transition-age youth by CIL professionals.
Results indicated that the factor structure proposed by Thompson was confirmed in a sample of CIL professionals. None of the agency or individual characteristics (i.e., number of high schools partnered with, number of students served, amount of training in transition services, and importance of collaboration between high schools and agencies for transition) predicted greater collaboration with LEAS. When analyzing the effects of degree of collaboration on the services provided, high ratings on three of the five collaborative dimensions predicted a higher likelihood of providing services to transition-age youth.
This study suggests that more training and experience of CIL professionals does not necessarily lead to greater collaboration. Additionally, the findings suggest that collaborative team structure is more important than social capital collaborative dimensions in leading to frequent services from CILs to transition-age youth. Implications for rehabilitation Extant literature suggests that secondary transition collaborative partnerships are critical to ensure students with disabilities have smooth transitions to adult life environments; The literature base calls for greater involvement from Centers for Independent Living (CILs) with local education agencies to maximize the benefit of youth with disabilities; This study suggests that more training and experience of CIL professionals does not necessarily lead to greater collaboration; and Collaborative team structure (i.e., Governance and Administration) is more important than social capital collaborative dimensions (i.e., Trust & Mutuality) in leading to frequent services from CILs to transition-age youth.