Search

Background: Paediatric critical care nurses face challenges in promptly detecting patient deterioration and delivering high-quality care, especially in low-resource settings (LRS). Patient monitors equipped with data-driven algorithms that monitor and integrate clinical data can optimise scarce resources (e.g. trained staff) offering solutions to these challenges. Poor algorithm output design and workflow integration, however, are important factors hindering successful implementation. This study aims to explore nurses' perspectives to inform the development of a data-driven algorithm and user-friendly interface for future integration into a continuous vital signs monitoring system for critical care in LRS. Methods: Human-centred design methods, including contextual inquiry, semi-structured interviews, prototyping and co-design sessions, were carried out at the high-dependency units of Queen Elizabeth Central Hospital and Zomba Central Hospital in Malawi between March and July 2023. Triangulating these methods, we identified what algorithm could assist nurses and used co-creation methods to design a user interface prototype. Data were analysed using qualitative content analysis. Results: Workflow observations demonstrated the effects of personnel shortages and limited monitor equipment for vital signs monitoring. Interviews identified four themes: workload and workflow, patient prioritisation, interaction with guardians, and perspectives on data-driven algorithms. The interviews emphasised the advantages of predictive algorithms in anticipating patient deterioration, underlining the need to integrate the algorithm's output, the (constant) monitoring data, and the patient's present clinical condition. Nurses preferred a scoring system represented with familiar scales and colour codes. During co-design sessions, trust, usability and context specificity were emphasised as requirements for these algorithms. Four prototype components were examined, with nurses favouring scores represented by colour codes and visual representations of score changes. Conclusions: Nurses in the LRS studied, perceived that data-driven algorithms, especially for predicting patient deterioration, could improve the provision of critical care. This can be achieved by translating nurses' perspectives into design strategies, as has been carried out in this study. The lessons learned were summarised as actionable pre-implementation recommendations for the development and implementation of data-driven algorithms in LRS. [ABSTRACT FROM AUTHOR]

This paper examines the semantic structuring of a paradigm of 89 minimizers, i.e., nouns that reinforce sentential negation in present-day Netherlandic Dutch, such as meter 'meter' in voor geen meter vertrouwen 'not to trust for a meter'. Cosine distances are computed on the basis of the predicates the minimizers combine with in a sample of 100 tokens downloaded from the Dutch Web corpus 2014 (nlTenTen14) and clustered according to the Partitioning Around Medoids (PAM) algorithm into nine semantic clusters. The clusters largely correspond to semantic categories such as taboo terms or units of money. This suggests that, in general, minimizers belonging to the same semantic domain are combined with a similar (core) set of predicates. Based on the shared predicates per cluster, we detect signs of analogical attraction between minimizers or, conversely, competition. Crucially, low silhouette widths enable us to identify outliers in their respective clusters, for instance, minimizing nouns that exhibit signs of context expansion, as shown by their combination with semantically non-harmonious verbs. As such, this paper provides a synchronic snapshot of the semantic processes involved in (incipient) grammaticalization of minimizing nouns and, more in general, it illustrates how distributional semantics offers a heuristic to analyze the structure of a network of comparable micro-constructions. [ABSTRACT FROM AUTHOR]

Introduction: Exposure to family risk factors increases adolescents' chances of attaining a lower educational level. However, some adolescents attain a high educational level despite being exposed to family risk factors such as a lower parental socioeconomic status (SES) or receiving less family support. Method: Using data from the Dutch TRAILS cohort study (NT1 = 2175; Mage = 11.1, SD = 0.55, 50.8% female), we investigated if higher levels of effortful control and peer support can buffer against the negative effects of a lower parental SES and less family support on educational level. Two multinomial logistic regressions were performed (from early to mid‐adolescence and from mid‐adolescence to young adulthood) with post hoc tests to contrast four ordinal educational levels: practical vocational, theoretical vocational, higher general, and (pre‐)university. Results: Adolescents with a higher parental SES were consistently more likely to end up at a higher educational level, but family support was hardly associated with educational level. Neither effortful control nor peer support buffered the associations of parental SES and family support with educational level. Effortful control did have a positive direct (compensatory) effect on the educational level. Conclusion: We conclude that other individual competencies or more structural changes may be more helpful buffers for reducing socioeconomic inequalities in educational attainment. [ABSTRACT FROM AUTHOR]

Despite the progress of anti-cancer treatment, the prognosis of many patients with solid tumors is still dismal. Reliable noninvasive biomarkers are needed to predict patient survival and therapy response. Here, we propose a Humoral Complementomics approach: a work-up of assays to comprehensively evaluate complement proteins, activation fragments, and autoantibodies targeting complement proteins in plasma, which we correlated with the intratumoral complement activation, and/or local production, focusing on localized and metastatic clear cell renal cell carcinoma (ccRCC). In two prospective ccRCC cohorts, plasma C2, C5, Factor D and properdin were elevated compared to healthy controls, reflecting an inflammatory phenotype that correlated with plasma calprotectin levels but did not associate with CRP or with patient prognosis. Conversely, autoantibodies against the complement C3 and the reduced form of FH (a tumor neo-epitope reported in lung cancer) correlated with a favorable outcome. Our findings pointed to a specific group of patients with elevated plasma C4d and C1s-C1INH complexes, indicating the initiation of the classical pathway, along with elevated Ba and Bb, indicating alternative pathway activation. Boostrapped Lasso regularized Cox regression revealed that the most predictive complement biomarkers were elevated plasma C4d and Bb levels at the time of surgery, which correlated with poor prognosis. In conclusion, we propose Humoral Complementomics as an unbiased approach to study the global state of the complement system in any pathological plasma sample and disease context. Its implementation for ccRCC revealed that elevated C4d and Bb in plasma are promising prognostic biomarkers, correlating with shorter progression-free survival. [ABSTRACT FROM AUTHOR]

Due to huge advancements in natural language processing (NLP) and machine learning, chatbots are gaining significance in the field of customer service. For users, it may be hard to distinguish whether they are communicating with a human or a chatbot. This brings ethical issues, as users have the right to know who or what they are interacting with (European Commission in Regulatory framework proposal on artificial intelligence. https://digital-strategy.ec.europa.eu/en/policies/regulatory-framework-ai, 2022). One of the solutions is to include a disclosure at the start of the interaction (e.g., "this is a chatbot"). However, companies are reluctant to use disclosures, as consumers may perceive artificial agents as less knowledgeable and empathetic than their human counterparts (Luo et al. in Market Sci 38(6):937–947, 2019). The current mixed methods study, combining qualitative interviews (n = 8) and a quantitative experiment (n = 194), delves into users' responses to a disclosed vs. undisclosed customer service chatbot, focusing on source orientation, anthropomorphism, and social presence. The qualitative interviews reveal that it is the willingness to help the customer and the friendly tone of voice that matters to the users, regardless of the artificial status of the customer care representative. The experiment did not show significant effects of the disclosure (vs. non-disclosure). Implications for research, legislators and businesses are discussed. [ABSTRACT FROM AUTHOR]

For diversity to exist in the medical graduate workforce, students from all backgrounds should have equitable opportunities of employment. Specialties have utilized a minimal threshold for USMLE Step 1 score when screening applicants for residency interviews. The OHSU SOM class of 2021 completed a 14-question voluntary survey on their Step 1 score and the following non-modifiable risk factors: Adverse Childhood Experience score (ACEs), sex, gender, Underrepresented in Medicine status (URiM), family income during adolescence, highest degree held by a guardian, discrimination experience during medical school, federal/state assistance use, and rural versus urban primary home. Descriptive statistics and unadjusted risk ratios were applied to study the relation between Step 1 score and non-modifiable risk factors as well as certain non-modifiable risk factors and ACEs ≥ 3. The mean Step 1 score was 230 (213, 247). Of the students, 28.2% identified ACEs ≥ 3, 13.6% were considered URiM, and 65.4% were female. URiM were 2.34 (1.30, 4.23), females were 2.77 (1.06–7.29), and those who experienced discrimination in medical school were 4.25 (1.85, 9.77) times more likely to have ACEs ≥ 3. Students who had ACEs ≥ 3 were 3.58 (1.75, 7.29) times less likely to meet a minimal threshold for residency interviews of 220. These are the first results to demonstrate a relationship between Step 1 score and ACEs. Those who identified as URiM, females, and those who experienced discrimination in medical school were at a higher risk of ACEs of ≥ 3. Step 1 transitioned to pass/fail in January 2022. However, the first application cycle that residencies will see pass/fail scoring is 2023–2024, and fellowships will continue to see scored Step 1 until, at the earliest, the 2026–2027 application cycle. These data contribute to a foundation of research that could apply to Step 2CK testing scores, and help to inform decisions about the diversity and equity of the residency interview process. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence To determine whether there is a correlation between preoperative coronal varus or valgus laxity and patient‐reported outcome measures (PROMs) 2 years after individualised total knee arthroplasty (TKA).Records of 150 consecutive patients who received individualised TKA were retrospectively analysed, and 126 with complete pre‐ and postoperative data were included. Preoperative coronal varus and valgus stress radiographs (15 N load) were taken using a telos stress device with the knee in 5°–10° of flexion. Varus stress angles were positive if the joint opened on the lateral side, and valgus stress angles were positive if the joint opened on the medial side. The sum of varus and valgus stress angles indicated total joint laxity. During surgery, cases that required tibial recuts to balance the joint were recorded. Patients completed three PROMs and rated their satisfaction. Correlations between laxity and PROMs were evaluated using Pearson's correlation.Stress radiographs revealed varus stress angles of 6.3° ± 3.5° (range, −4.5° to 14.1°), valgus stress angles of 0.1° ± 3.7° (range, −8.0° to 10.9°), and the sum of the varus and valgus stress angle of 6.4° ± 3.3° (range, 0.1° to 17.1°). There were no correlations between laxity and PROMs: r < 0.160 for varus stress angle, r < 0.180 for valgus stress angle and r < 0.160 for the sum of stress angles. There were no statistically significant or clinically relevant differences in PROMs between knees without and those with tibial recuts.Preoperative coronal varus or valgus laxity was not correlated with PROMs following individualised TKA at a minimum 2‐year follow‐up. Individualised TKA with personalised alignment enables adequate accommodation of a broad spectrum of preoperative coronal varus–valgus laxities.IV [ABSTRACT FROM AUTHOR]

In this study, a C–CoFe 2 O 4 composite is proposed for reduction in an induction heating reactor with a continuous argon flow. An impressive conversion efficiency of 87% is achieved at a maximum temperature of 325 °C in just 8 min without the need for vacuum. The impact of the molar ratio of metal oxide to reducing agent (acetylacetone) is also examined. Results indicate that a 1:1 ratio favours the reduction towards cobalt and iron monoxides, while a 1:3 ratio yields a 31% metal phase. The highest conversion (87%) is seen with a 1:17 ratio, indicating the need for excess reducing agent for effective conversion of CoFe 2 O 4 oxide. The molar ratio influences the induction heating temperature, with the 1:17 ratio having a lower temperature of 325 °C compared to 450 °C for other ratios. These operating temperatures (≤450 °C) are significantly lower than those reported in the literature for carbothermal reduction in an induction reactor (>1700 °C), which often requires vacuum and very high temperatures for high conversion efficiency. The proposed process offers advantages such as high conversion efficiency, fast processing, and simpler operational conditions. Additionally, the metallic phases produced are utilized for H 2 production in thermochemical water splitting, showcasing these materials potential for energy generation applications. [Display omitted] • Induction heated C–CoFe 2 O 4 achieves 87 % metal oxide-to-metal conversion at 325 °C. • This method results in a faster and more efficient reduction process at lower T. • Reduction efficiency is influenced by molar ratio of metal oxide to reducing agent. • The metallic phase is applied for thermochemical H 2 production (3.905 mmol H 2 g−1). [ABSTRACT FROM AUTHOR]

Aims: To provide (1) an overview of core characteristics of scoping and mapping review methodologies and (2) to illustrate the differences and similarities of these methodologies using literature on nursing mobile workstations. Design: Systematic review. Methods: Systematic searches were conducted to identify (1) scoping and mapping review methodologies used in the field of nursing and (2) literature on nursing mobile workstations. For each systematic search, two reviewers independently screened all titles, abstracts, and full texts. We conducted narrative syntheses for both review questions. Publications on scoping and mapping review methodologies in the field of nursing were searched in MEDLINE (PubMed), Web of Science, Scopus, and CINAHL (September 2022). Publications on nursing mobile workstations were searched in MEDLINE (PubMed), CINAHL, and Web of Science (April 2022). Results: We identified six scoping and mapping review methodologies (aim 1): bibliometric analysis, evidence mapping, focused mapping review and synthesis, and scoping review. The methodologies aim to provide a graphical, tabular, or narrative overview without a formal critical assessment of the literature. We provide an overview of key variables that reflect the different focus of these methodologies. We also included 26 publications on nursing mobile workstations (aim 2). Nineteen different terms were used to describe the workstations. An overall definition of the nursing mobile workstation was not found. Conclusion: Scoping and mapping methodologies are regularly applied in nursing research. Although there is overlap between the different methodologies, we found some unique characteristics. Despite the regular use of nursing mobile workstations, little is known about their impact in care processes and important features. Future studies on nursing mobile workstations could explore the impact of the workstations in the care process and the current functions of the workstations. A universal definition of the workstations is warranted. Clinical Relevance: Most publications address aspects of practicability of nursing mobile workstations, but we found no universal definition. Little knowledge is available on the impact of the workstations in clinical practice. [ABSTRACT FROM AUTHOR]

Public inquiries into matters of conflict and security are vitally important yet undertheorised. This article explores the potential of inquiries for the democratic scrutiny of foreign policy, military doctrine, and grand strategy. In recent decades, there have been numerous inquiries into contentious foreign and security policy incidents in Britain, a trend reflected elsewhere in global politics. Inquiries can unveil facts, identify lessons, and rebuild trust. But critics claim that inquiries overlook systemic flaws. Our analysis transcends the usual arguments for or against public inquiries by explaining how inquiries produce knowledge and how this could be improved. We argue that inquiries necessarily involve the following three distinct processes: scandalisation, archivisation, and epistemology. We suggest how future inquiries could overcome extant limitations through a broader scope, diversification of evidence, and methodological pluralism. Such inquiries can play an improved role in promoting reflection and dialogue about a just international order and Britain's role within it. [ABSTRACT FROM AUTHOR]

Rationale: No drugs are currently validated to treat psychostimulant use disorder (PUD). Pathophysiological studies consistently highlight the contribution of cholinergic mechanisms in psychostimulant use, including the vulnerability to PUD, paving the way for potential therapeutic strategies. Objectives: The aim of this systematic review is to describe and discuss the efficacy of cholinergic agents in drug trials for patients with PUD. Methods: A systematic review was conducted on April 4, 2024 in MedLine, Embase and Cochrane Library databases on controlled clinical drug trial of cholinergic agents in humans with PUD, psychostimulant abuse or dependence and psychostimulant use in recent year. Results: Twenty-eight articles were included, twenty-one on cocaine and seven on amphetamines. Cholinergic agents used in these studies were biperiden (a muscarinic antagonist), mecamylamine (a nicotinic antagonist), nicotinic agonists, acetylcholinesterase inhibitors (AChEI), or citicoline. Two types of trials were identified. There were seventeen randomized controlled clinical trials evaluating cholinergic agents on psychostimulant use reduction in outpatients seeking treatment. Additionally, we retrieved eleven short-term «proof-of-concept» laboratory trials mainly with supervised psychostimulant administration and/or triggered craving challenges. Outpatient trials were heterogeneous and for most, inconclusive. Only two studies on galantamine (AChEI) and citicoline, reported a significant reduction of cocaine consumption. «Proof-of-concept» laboratory trials showed no evidence of efficacy on the selected outcomes, notably on craving. Conclusions: This review does not support the current prescription of cholinergic agents to treat PUD. Replication clinical trials notably on galantamine or other AChEI, and proof-of-concept trials on comedown symptoms will be necessary to identify a potential therapeutic indication for cholinergic agents in PUD. [ABSTRACT FROM AUTHOR]

On April 4, 2018, Newfoundland and Labrador Supreme Court Justice Robert Fowler issued a landmark decision in C.C. (Re) [2018] NLSC 71 Carswell Nfld 110 making three adults—in a polyamorous relationship with one another—the legal parents to their young daughter. This was a significant decision in Canada, since Newfoundland and Labrador was the first jurisdiction to grant legal parental status to adults in a polyamorous relationship. In 2021, British Columbia's Supreme Court made a similar decision in British Columbia Birth Registration No. 2018-XX-XX5815, 2021 BCSC 767. While these cases seem progressive, proponents of the legal and social expansion of parentage should remain cautious. The decisions' potential for changing the landscape of family law and social perceptions of non-dyadic parenting are stymied by the persistence of privatised sex and gender norms and racialised constructions of sexuality. [ABSTRACT FROM AUTHOR]

Thinking about our own death and its salience in relation to decision making has become a fruitful area of multidisciplinary research across the breadth of psychological science. By bringing together experts from philosophy, cognitive and affective neuroscience, clinical and computational psychiatry we have attempted to set out the current state of the art and point to areas of further enquiry. One stimulus for doing this is the need to engage with policy makers who are now having to consider guidelines on suicide and assisted suicide so that they may be aware of their own as well as the wider populations' cognitive processes when confronted with the ultimate truth of mortality. [ABSTRACT FROM AUTHOR]

Two Mn-phosphinophosphinine complexes were synthesised from reaction of the proligand with [MnBr(CO)5] at 80 °C for 2 h; 2-diphenylphosphino-3-methyl-6-trimethylsilylphosphinine manganese tricarbonyl bromide (2TMS) and 2-diphenylphosphino-3-methyl-phosphinine manganese tricarbonyl bromide (2H). 31P{1H} NMR spectroscopy revealed characteristic chemical shifts for the phosphinine and phosphine donors bound to Mn (255.4 and 23.7 ppm for 2TMS; 234.2 and 24.8 ppm for 2H), and single crystal X-ray diffraction established the structure of the chelating complex 2TMS. Rapid reaction of both complexes with water was observed with 2TMS reacting to eventually yield a single product, syn-3TMS, from the syn-1,2-addition of water across the P＝C multiple bond on the bromide face, confirmed by X-ray diffraction for both an unsolvated and solvated structure, where MeOH was found to be H-bonding to the P-OH functionality. The reaction of 2R with dry methanol gave multiple products that were not in equilibrium with each other, and the molecular structure of one isomer was definitively established by X-ray diffraction as an unusual 1,4-addition product (1,4-4TMS). However, reaction of 2R with methanol in the presence of trace water showed that hydrolysis products 3R were formed preferentially. Both phosphinine complexes acted as pre-catalysts for the Guerbet upgrading of methanol/ethanol to isobutanol at 180 °C over 90 h, giving yields of isobutanol (based on moles of ethanol) of 22% for 2TMS and 27% for 2H. This is superior to known Mn dppm complexes [dppm = bis(diphenylphosphino)methane], including the 21% yield recorded for the best derivative [MnBr(κ2-PPh2C(H)PhPPh2)(CO)3] shown to date. [ABSTRACT FROM AUTHOR]

Endothelial cells are key players in the cardiovascular system. Among other things, they are responsible for sprouting angiogenesis, the process of new blood vessel formation essential for both health and disease. Endothelial cells are strongly regulated by the juxtacrine signaling pathway Notch. Recent studies have shown that both Notch and angiogenesis are influenced by extracellular matrix stiffness; however, the underlying mechanisms are poorly understood. Here, we addressed this challenge by combining computational models of Notch signaling and YAP/TAZ, stiffness- and cytoskeleton-regulated mechanotransducers whose activity inhibits both Dll4 (Notch ligand) and LFng (Notch-Dll4 binding modulator). Our simulations successfully mimicked previous experiments, indicating that this YAP/TAZ-Notch crosstalk elucidates the Notch and angiogenesis mechanoresponse to stiffness. Additional simulations also identified possible strategies to control Notch activity and sprouting angiogenesis via cytoskeletal manipulations or spatial patterns of alternating stiffnesses. Our study thus inspires new experimental avenues and provides a promising modeling framework for further investigations into the role of Notch, YAP/TAZ, and mechanics in determining endothelial cell behavior during angiogenesis and similar processes. [ABSTRACT FROM AUTHOR]

Small pelagic fish (SPF) are crucial in marine food webs, transferring energy from plankton to higher trophic levels. This study focuses on herring (Clupea harengus) and sprat (Sprattus sprattus), addressing knowledge gaps in their feeding ecology in a nursery area, the Dutch Wadden Sea. We conducted a year-long, monthly survey, and used DNA metabarcoding to analyse zooplankton samples and stomach contents of two size classes of herring and sprat. Intra-, interspecific, and seasonal variations in fish condition, stomach fullness, and diet composition, along with selective feeding, were studied. Our study showed that condition and diet composition of herring and sprat, along with zooplankton density, exhibited a clear seasonal pattern. Juvenile herring and sprat displayed opportunistic feeding behaviour, rather than showing distinct prey selection. Besides copepods, we regularly observed (larvae of) benthic invertebrates in their diet. This emphasizes the crucial role of SPF as energy transfer agents, not solely between trophic levels, but also from benthic to pelagic habitats. Furthermore, fish post-larvae were part of the diet of larger herring (10–15 cm). Because of its unprecedented temporal and taxonomical detail, this study advances the understanding of seasonal dynamics of dominant components at the base of the Wadden Sea food web. [ABSTRACT FROM AUTHOR]

Neurosurgery is a field with complex ethical issues. In this article, we aim to provide an overview of key and emerging ethical issues in neurosurgery with a focus on issues relevant to practicing neurosurgeons. These issues include those of informed consent, capacity, clinical trials, emerging neurotechnology, innovation, equity and justice, and emerging bioethics areas including community engagement and organizational ethics. We argue that bioethics can help neurosurgeons think about and address these issues, and, in turn, the field of bioethics can benefit from engagement by neurosurgeons. Several ideas for increasing engagement in bioethics are proposed. [ABSTRACT FROM AUTHOR]

Marine heatwaves (MHWs) are extreme weather events that have major impacts on the structure and functioning of marine ecosystems worldwide. Due to anthropogenic climate change, the occurrence of MHWs is predicted to increase in future. There is already evidence linking MHWs with reductions in biodiversity and incidence of mass mortality events in coastal ecosystems. However, because MHWs are unpredictable, the quantification of their effects on communities is challenging.Here, we use the Helgoland Roads long‐term time series (German Bight, North Sea), one of the richest marine time series in the world, and implement a modified before‐after control‐impact (BACI) design to evaluate MHW effect on mesozooplankton communities. Mesozooplankton play an essential role in connecting primary producers to higher trophic levels, and any changes in their community structure could have far‐reaching impacts on the entire ecosystem.The responses of mesozooplankton community to MHWs in terms of community structure and densities occurred mainly in spring and autumn. Abundances of seven taxa, including some of the most abundant groups (e.g. copepods), were affected either positively or negatively in response to MHWs. In contrast, we observed no clear evidence of an impact of summer and winter MHWs; instead, the density of the most common taxa remained unchanged.Our results highlight the seasonally dependent impacts of MHWs on mesozooplankton communities and the challenges in evaluating those impacts. Long‐term monitoring is an important contributor to the quantification of effects of MHWs on natural populations. [ABSTRACT FROM AUTHOR]

This narrative inquiry highlights the first year of a 5-year Jacob K. Javits grant. In it, the authors detail their experiences writing and receiving the grant and beginning the equity-focused work of helping develop and expand gifted education in Michigan. Michigan currently has no gifted education legislation or funding, so this Javits team began the work to build an equitable system using the most recent research in our field. Given the lack of a playbook for building an equitable gifted education program from the start, through narrative methods, the authors share not only their actions, but also the challenges, internal and external, which threatened, and continue to threaten, the success of the project. They argue that choosing action over conflicting emotions enables them to show up, ready or not, to fight for the dignity of gifted children everywhere. [ABSTRACT FROM AUTHOR]

In August 1916, in the aftermath of significant defeats in the Middle Eastern theatre of the First World War, the British government faced a crisis of confidence in its military power. In Mesopotamia, it was under significant pressure to reckon with its perceived poor strategic decision-making and its treatment and resourcing of British troops. The Mesopotamia Commission was established to investigate and reassure the wider public that the same mistakes would not be made again. Scholarly explorations of the commission have focused on the commission's report published in July 1917. But this neglects what came before: the construction, performance, and repercussions of the commission as it unfolded. This article undertakes a forensic archival analysis of the commission 'in process', revealing the political character of the commission—how it presented itself, the commissioner's decision-making, and the intra-imperial conflicts it aggravated during the war itself—all while operating under (and benefitting from) an expert, impartial guise. This granular approach to inquiry analysis not only contributes to new understandings of British imperial politics during the First World War but also demonstrates that, as a selective process of knowledge production, the commission's outcomes and impact went well beyond just a published report. [ABSTRACT FROM AUTHOR]

This paper presents the observations of predation by the grouper Epinephelus quoyanus on sea turtle hatchlings in Chagar Hutang bay, Redang Island, Malaysia. Two of the eight collected specimens had hatchlings in their guts, whereas the remaining specimens had empty stomachs. This field report provides an in‐depth understanding of the E. quoyanus diet and new insights into its feeding behavior. [ABSTRACT FROM AUTHOR]

This article explores the potential for enhancing anti-tumor immunity in chemotherapy-treated urothelial carcinoma by targeting the cGAS-STING pathway. The study reveals that while chemotherapies can activate this pathway, it does not always result in the production of type I interferon due to the inhibitory effects of the transcription factor ATF3. The researchers investigated the impact of different chemotherapy combinations on urothelial carcinoma and bladder cancer cell lines and found that while they induced an inflammatory response and markers of immunogenic cell death, they did not effectively activate the immune system. The study provides valuable insights into the mechanisms of chemotherapy-induced immune responses and suggests potential targets for improving anti-tumor immunity in urothelial carcinoma. [Extracted from the article]

Crop disease often leads to field epidemics with serious threats to yield. Early symptoms are sometimes difficult to identify, so the origin of primary inoculum is a critical focal point in the study of plant diseases, as it can help design management strategies to reduce crop losses. Here, we investigated whether anthracnose of water yams (Dioscorea alata L.) caused by the species complex Colletotrichum gloeosporioides can start from infected seed tubers from the previous harvest. Over two years, we collected tubers with varying pathogen prevalence in the field directly from producers and conducted fungal isolations in the lab to sample C. gloeosporioides. We also proceeded to artificially inoculate tubers before planting and monitored disease development. Finally, we genotyped isolates from leaves in the fields and assessed fixation indices between plots based on plot ownership (plots with a common seed tuber origin from a single farmer) vs. samples in plots from unrelated producers in Guadeloupe, Martinique, and Barbados. We were unable to isolate the fungus from harvested tubers in either sampling survey nor did any plants grown from inoculated tubers develop any disease symptoms during growth. Also, the genetic structure of samples within each plot was independent of plot ownership, though this occurred with varying levels in the different islands. These results suggest that contaminated planting material from seed tubers is not the primary source of the disease, which is in contrast to the common perception of yam anthracnose prevalence in the Antilles. [ABSTRACT FROM AUTHOR]

U.S. State Hazard Mitigation Plans (SHMPs) identify hazards, locate jurisdictional vulnerabilities and risks, and prioritize state hazard mitigation actions. As environmental hazards become more prevalent and costlier due to climate change, these mitigation plans and activities serve as critical decision-making tools for disaster risk reduction. This investigation systematically evaluates all fifty SHMPs on Hazards Identification and Risk Assessment (HIRA) quality. This assessment of HIRA quality examines three elements: (1) adherence to FEMA HIRA requirements; (2) incorporation of social vulnerability analysis; and (3) risk assessment methodology. The evaluation considers the new FEMA requirements and additional best practices to illustrate necessary improvements as states undergo revisions for their next SHMP update. Results find that most states meet a majority of FEMA's plan requirements. Still, only twenty-seven SHMPs examine either social vulnerability or hazard risk at the sub-state level, and only seven states consider both. Ignoring sub-state variability in vulnerability and hazard risk can lead to misunderstanding true hazard risk at the local level, inequitable mitigation planning, and higher rates of future loss among underserved populations. Plans that employ a quantitative risk scoring methodology score higher on average, serving as best practice examples for SHMP improvement. [ABSTRACT FROM AUTHOR]

Research shows that restrictive immigration policies and practices are associated with poor health, but far less is known about the relationship between inclusive immigration policies and health. Using data from the United States natality files, we estimate associations between state laws granting undocumented immigrants access to driver's licenses and perinatal outcomes among 4,047,067 singleton births to Mexican and Central American immigrant birthing people (2008–2021). Fitting multivariable log binomial and linear models, we find that the implementation of a license law is associated with improvements in low birthweight and mean birthweight. Replicating these analyses among U.S.-born non-Hispanic White birthing people, we find no association between the implementation of a license law and birthweight. These findings support the hypothesis that states' extension of legal rights to immigrants improves the health of the next generation. [ABSTRACT FROM AUTHOR]

For those affected, infertility is linked to impaired overall health and reduced life expectancy. In particular, infertile individuals bear an increased risk for cardiovascular disease (CVD) and different types of cancer, partially due to lifestyle differences and to genetic alterations that cause both infertility and an increased cancer risk. Genetic variants causing an increased CVD risk are more commonly found in infertile individuals, but their link to infertility remains unclear. Offspring of infertile couples, conceived via medically assisted reproduction, are as likely as their parents to exhibit or develop adiposity, hormonal alterations such as insulin resistance, and infertility. The effects on health of subsequent generations are completely unclear. [ABSTRACT FROM AUTHOR]

Objectives: Root resorption in permanent teeth is a common pathological process that often follows dental trauma or orthodontic treatment. More rarely, root resorption is a feature of genetic disorders and can help with diagnosis. Thus, the present review aims to determine which genetic disorders could induce pathological root resorptions and thus which mutated genes could be associated with them. Methods: We conducted a systematic review following the PRISMA guidelines. Articles describing root resorptions in patients with genetic disorders were included from PubMed, Embase, Web of Science, and Google Scholar. We synthesized the genetic disorder, the type, severity, and extent of the resorptions, as well as the other systemic and oral symptoms and histological features. Results: The synthetic analysis included 25 studies among 937 identified records. We analyzed 21 case reports, three case series, and one cohort study. Overall, we highlighted 14 different pathologies with described root resorptions. Depending on the pathology, the sites of resorption, their extent, and their severity showed differences. Conclusion: With 14 genetic pathologies suspected to induce root resorptions, our findings are significant and enrich a previous classification. Among them, three metabolic disorders, three calcium–phosphorus metabolism disorders, and osteolysis disorders were identified. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence that beta-blockers may provide benefit for patients with moderate-severe traumatic brain injury (TBI) during the acute injury period. Larger studies on utilization patterns and impact on outcomes in clinical practice are lacking. Objective: The present study uses a large, national hospital claims-based dataset to examine early beta-blocker utilization patterns and its association with clinical outcomes among critically ill patients with moderate-severe TBI. Methods: We conducted a retrospective cohort study of the administrative claims Premier Healthcare Database of adults (≥17 years) with moderate-severe TBI admitted to the intensive care unit (ICU) from 2016 to 2020. The exposure was receipt of a beta-blocker during day 1 or 2 of ICU stay (BB+). The primary outcome was hospital mortality, and secondary outcomes were: hospital length of stay (LOS), ICU LOS, discharge to home, and vasopressor utilization. In a sensitivity analysis, we explored the association of beta-blocker class (cardioselective and noncardioselective) with hospital mortality. We used propensity weighting methods to address possible confounding by treatment indication. Results: A total of 109 665 participants met inclusion criteria and 39% (n = 42 489) were exposed to beta-blockers during the first 2 days of hospitalization. Of those, 42% received cardioselective only, 43% received noncardioselective only, and 14% received both. After adjustment, there was no association with hospital mortality in the BB+ group compared to the BB− group (adjusted odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.94, 1.04). The BB+ group had longer hospital stays, lower chance of discharged home, and lower risk of vasopressor utilization, although these difference were clinically small. Beta-blocker class was not associated with hospital mortality. Conclusion: In this retrospective cohort study, we found variation in use of beta-blockers and early exposure was not associated with hospital mortality. Further research is necessary to understand the optimal type, dose, and timing of beta-blockers for this population. [ABSTRACT FROM AUTHOR]

In August 1916, in the aftermath of significant defeats in the Middle Eastern theatre of the First World War, the British government faced a crisis of confidence in its military power. In Mesopotamia, it was under significant pressure to reckon with its perceived poor strategic decision-making and its treatment and resourcing of British troops. The Mesopotamia Commission was established to investigate and reassure the wider public that the same mistakes would not be made again. Scholarly explorations of the commission have focused on the commission's report published in July 1917. But this neglects what came before: the construction, performance, and repercussions of the commission as it unfolded. This article undertakes a forensic archival analysis of the commission 'in process', revealing the political character of the commission—how it presented itself, the commissioner's decision-making, and the intra-imperial conflicts it aggravated during the war itself—all while operating under (and benefitting from) an expert, impartial guise. This granular approach to inquiry analysis not only contributes to new understandings of British imperial politics during the First World War but also demonstrates that, as a selective process of knowledge production, the commission's outcomes and impact went well beyond just a published report. [ABSTRACT FROM AUTHOR]

The article describes the case of a 79-year old Caucasian man who was treated with donepezil after developing a pruritic erythematous maculopapular eruption at the application site of rivastigmine transdermal patches, which was used to treat his Lewy body disease. The patient's skin lesions did not regress after antihistaminic treatment with cetirizine. A Naranjo scale assessment showed the high probability of the relation of cutaneous adverse effects with rivastigmine transdermal patches.

Poor sleep is frequently reported in children with neuromuscular diseases (NMD) and cerebral palsy (CP) however breathing disorders during sleep are often the clinical focus. Periodic limb movements (PLMs) have an increased prevalence in adults with NMD and may contribute to sleep disturbance in this population. We assessed the prevalence of PLMs in children with NMD or CP. Retrospective review of polysomnography (PSG) with leg electromyography in children age 1–18 years with NMD (including Duchenne muscular dystrophy, myotonic dystrophy, spinal muscular atrophy) or CP performed at a paediatric sleep centre 2004–2022. Leg electromyography was available in at least 1 PSG in 239 children (125 NMD, 114 CP), and in 2 PSGs in 105 children (73 NMD, 32 CP). At initial PSG, 72 (30 %) were female with a median age 9y and respiratory disturbance index 3.5/h (interquartile range 1.3–9.9/h). Elevated PLM index (PLMI; >5/h) occurred in 9.6 % of each of the CP and NMD groups, quantified by initial PSG. Overall, PLMI increased from baseline (median 0, maximum 33/h) to follow-up (median 0, maximum 55.8/h; p < 0.05). In those with an elevated PLMI, arousal percentage attributable to PLMs was up to 25 % (median 7.5 %). Elevated PLMI occurred at a higher prevalence in children with NMD and CP than reported in other clinic-referred paediatric populations. It is important that PLMs are not overlooked as identification and treatment may help improve sleep outcomes. Further research is required to understand the pathophysiology and consequences of PLMs specifically in this population. • Children with neuromuscular disease (NMD) or cerebral palsy have high rates of sleep disturbance. • Periodic limb movements are not consistently measured in NMD or cerebral palsy populations. • Children with NMD or cerebral palsy have high prevalence of elevated periodic limb movement index. • Frequency of periodic limb movements increased over time. • Research is needed to understand the consequences and treatment implications in this population. [ABSTRACT FROM AUTHOR]

Although maternal stress during pregnancy and even before conception shapes offspring risk for mental health problems, relatively little is known about the mechanisms through which these associations operate. In theory, preconception and prenatal stress may affect offspring mental health by influencing child responses to postnatal caregiving. To address this knowledge gap, this study had two aims. First, we examined associations between preconception and prenatal stress with child temperament profiles at age four using multilevel assessment of maternal perceived stress and stress physiology. Second, we tested child temperament profiles as moderators of associations between observed parenting behaviors during a parent–child free-play interaction when children were 4 years old and child behavior problems 1 year later. Latent profile analyses yielded four distinct child temperament profiles: inhibited, exuberant, regulated low reactive, and regulated high reactive. Consistent with hypotheses, preconception, and prenatal stress each independently predicted the likelihood of children having temperament profiles characterized by higher negative emotionality and lower regulation. Specifically, preconception perceived stress and prenatal cortisol predicted likelihood of children having an exuberant temperament, whereas prenatal perceived stress predicted likelihood of children having an inhibited temperament. Contrary to hypotheses, temperament profiles did not moderate predictions of child behavior problems from observed parenting behaviors; however, responsive parenting behaviors inversely predicted child behavior problems independently of child temperament. These findings add to growing evidence regarding effects of preconception factors on child outcomes and underscore a central role for responsive parenting behaviors in predicting more favorable child mental health independent of child temperament. Public Significance Statement: While prior work has demonstrated prenatal and even preconception developmental origins of psychopathology risk, elucidating the independent and joint effects of preconception, prenatal, and postnatal factors on child mental health is critical to innovate and maximize intervention and prevention efforts. In the present study, preconception and prenatal stress each independently predicted child temperament; however, postnatal responsive parenting behaviors were associated with lower child behavior problems regardless of child temperament. These findings inform understanding of distinct preconception, prenatal, and postnatal influences on child outcomes. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has demanded crisis management at all governance levels. While most research has focused on responses of national governments, city-level governance had significant potential to develop tailored approaches. This study explored how the local COVID-19 response was organised and adapted to the specific city population and context in the City of Antwerp, Belgium. Methods: A case study using semi-structured interviews was set up with 20 key informants with a central role in the coordination and implementation of the city-level COVID-19 response in Antwerp. Thematic analysis of transcripts was guided by an adapted version of the OECD risk management cycle. Results: Respondents' accounts provide a granular understanding of pandemic preparedness, crisis management, and response and adaptation to the COVID-19 crisis in a mid-size European city. Its size was large enough to have a strong capacity within its government bodies, to utilise the expertise of strong partners in the area and to mobilise a critical mass for action, yet small enough to quickly establish connections and trust. In addition to a universal approach, they developed tailored responses to specific neighbourhoods and groups. Well-established community and organisational ties enhanced the effectiveness of grassroots initiatives. The perceived feeling of joint action contributed to a strong collective agency, but respondents noted the need for a system for monitoring and learning. Conclusions: Local governments are important to develop tailored strategies and organise a locally relevant crisis response in cities. They need expertise and agency, with enough flexibility to experiment. To harness promising practices and avoid repeating errors in future crises, it is crucial to develop a system that better evaluates and monitors local responses, before, during and after crises. [ABSTRACT FROM AUTHOR]

Climate change is accelerating the increase of temperatures across the planet and resulting in the warming of oceans. Ocean warming threatens the survival of many aquatic species, including squids, and has introduced physiological, behavioral, and developmental changes, as well as physical changes in their biological materials composition, structure, and properties. Here, we characterize and analyze how the structure, morphology, and mechanical properties of European common squid Loligo vulgaris sucker ring teeth (SRT) are affected by temperature. SRT are predatory teethed structures located inside the suction cups of squids that are used to capture prey and are composed of semicrystalline structural proteins with a high modulus (GPa-range). We observed here that this biological material reversibly softens with temperature, undergoing a glass transition at ∼35°C, to a MPa-range modulus. We analyzed the SRT protein nanostructures as a function of temperature, as well as microscale and macroscale morphological changes, to understand their impact in the material properties. The results suggested that even small deviations from their habitat temperatures can result in significant softening of the material (up to 40% in modulus loss). Temperature changes following recent global climate trends and predictions might affect environmental adaptation in squid species and pose emerging survival challenges to adapt to increasing ocean temperatures. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a sleep disorder characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. Continuous positive airway pressure (CPAP) is a method used as a first-line treatment for obstructive sleep apnea (OSA). However, intolerance and resistance to CPAP can limit its long-term effectiveness. Alternative treatments are available, such as Mandibular Advancement Devices (MADs), positional therapy, upper airway surgery, and maxillomandibular osteotomy. However, often less efficient in reducing the apnea-hypopnea index, the higher tolerance of and compliance to alternative treatment has resulted in the adequate treatment of OSA in CPAP-intolerant patients. This paper describes the protocol of a prospective single-center cohort study including adult patients with moderate to severe OSA (15 events/h ≤ apnea-hypopnea index (AHI) < 65 events/h) that failed to comply with CPAP therapy. Selected patients will be invited to the clinic to explore alternative treatment options where DISE will be a first step in further identifying upper airway collapse during sleep. By exploring alternative treatment options in CPAP-intolerant patients and systematically documenting their treatment paths, an algorithm can be defined to better guide patients towards personalized treatment for OSA. The follow-up is aimed at 5 years with an inclusion of 170 patients per year, including a drop-out rate of 15%. By leveraging a real-world database, this study aims to bridge the gap between research and clinical practice, facilitating the development of evidence-based guidelines and personalized treatment algorithms for CPAP-intolerant patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Perineural anesthesia of the tibial nerve can be performed ultrasound-guided or blindly, with the latter still being commonly used in equine practice due to practical constraints, despite its lower accuracy and hence, its common failure to achieve desensitization. This may be associated with anatomical variations or inadequate landmarks for injection. In this anatomical study on the course of the tibial nerve on paired cadaveric limbs, we found that problems with perineural anesthesia cannot simply be attributed to anatomical variations. The large diameter of the tibial nerve (6 ± 1 mm) and the substantial amount of perineural tissue may present specific challenges for achieving adequate desensitization. Regarding landmarks, this study confirms that perineural injection should be performed 10 cm proximal to the proximocranial aspect of the calcaneal tubercle and 11 mm cranial to the superficial digital flexor. Perineural anesthesia of the tibial nerve can be performed ultrasound-guided or blindly, with the latter still being commonly used in equine practice due to practical constraints, despite its lower accuracy and hence, common failure to achieve desensitization. This may be associated with anatomical variations or inadequate landmarks for injection. To examine the course of the tibial nerve, document potential anatomical variations, and determine optimal landmarks for perineural injection, dissection was conducted along the medial aspect of the tibia in 10 paired cadaver hindlimbs. No anatomical variations of the tibial nerve were observed. Mean tibial nerve thickness was 6 ± 1 mm. The junction with the plantar nerves was located at a maximum of 85 mm and the junction with the medial cutaneous branch was at a maximum of 150 mm proximal to the proximal aspect of the calcaneal tubercle. The mean distance of the tibial nerve to the cranial border of the superficial digital flexor was 11 ± 6 mm. In conclusion, problems with perineural anesthesia of the tibial nerve cannot simply be attributed to anatomical variations. The thickness of the nerve and the amount of perineural tissue may present specific challenges for achieving adequate desensitization. Our results support the generally recommended site for tibial nerve perineural injection at 100 mm proximal to the calcaneal tubercle and 11 mm cranial to the superficial digital flexor. [ABSTRACT FROM AUTHOR]

Objective: To identify the technology and connectivity issues in rural and remote general practices, and the factors independently associated with these issues that negatively impact staff's capability to perform their job. Methods: An annual cross‐sectional survey of rural and remote general practice managers. Dependent variables included demographic data, practice size, geographic location, connection type and frequency of connectivity issues. Descriptive statistics are presented, and bivariate logistic regression was undertaken to determine factors independently associated with connectivity issues that negatively impact staff's capability to perform their job. Participants: One hundred sixty‐eight general practice managers from rural and remote New South Wales. Results: The majority of respondents (87%, n = 146) indicated that technology and connectivity issues had impacted staff's capability to perform their job. Internet problems were the most frequently reported issue (36%, n = 61). In bivariate analysis, practices that had a total clinical staff headcount between 5 and 7 (OR 0.27; 95% CI 0.10–0.67; p = 0.005) or between 8 and 11 (OR 0.39; 95% CI 0.16–0.95; p = 0.038) were significantly less likely to report technology and connectivity issues that negatively impact staff's capability to perform their job, compared with practices with a total clinical headcount of less than five. Conclusions: Technology and connectivity issues persist in rural and remote general practices. This is the first study to demonstrate that technology and connectivity issues impact on rural staff's capability to perform their job. Furthermore, smaller practices face more technology and connectivity issues that negatively impact staff's capability to do their job than larger practices. Further research is required to find solutions to address these challenges. [ABSTRACT FROM AUTHOR]

Background Objectives Scope Methods Results Conclusion Clinician‐teachers, physicians with educational responsibilities in either classroom or clinical setting, are assumed to add value by virtue of their dual role. The clinical responsibilities are often prioritised over the educational tasks. How and under which circumstances clinician‐teachers are able to perform their educational role and create added value for different stakeholders is currently unclear.To identify for whom, how and under which circumstances educational activities executed by CTs by virtue of their dual role add value to others.CTs activities linking the system of education and clinical practice beyond direct patient interactions and purposefully executed.A realist review was conducted. Databases were searched in two stages: a narrow conventional search, followed by a comprehensive artificial intelligence‐aided search. Studies concerning clinician‐teachers' dual role were included. Realist analysis was applied to identify in which contexts resource mechanisms triggered reasoning mechanisms, which led to specific outcomes for different stakeholders.Sixty‐six studies were included. In contexts where clinician‐teachers' dual role was formally recognised and valued, clinician‐teachers benefitted from the credibility and legitimacy bestowed on them, making the transfer of domain‐specific knowledge more impactful. In contexts where sociocultural differences between both systems existed, CTs were able to mediate and adjust recommendations aligned with stakeholders' perceived relevance. Also, contexts organised to support both roles made resource mechanisms more impactful. Clinician‐teachers added value to students' clinical competency and learning environment, and to educational organisations' curricular innovation. In their clinical workspace, clinician‐teachers added value by enhancing colleague physicians' teaching expertise, implementing educational innovations and recruiting students for scarce specialisms.Clinician‐teachers add value to students, colleague physicians and the clinical and educational contexts at large. Domain‐specific knowledge of both systems was important to gain credibility and achieve added value. Openness, formal recognition and allocated time for both roles in educational and clinical contexts towards the dual role are important to strengthen the impact of the dual role. [ABSTRACT FROM AUTHOR]

Detailed information on forest tree species is crucial to inform management and policy and support environmental and ecological research. Sentinel-2 imagery is useful for obtaining spatially explicit and frequent information on forest tree species due to its suitable spatial, spectral, and temporal resolutions. However, classification workflows often do not generalise well to time periods that are not seen by the model during the calibration phase. This study investigates the temporal transferability of dominant tree species classification. To this end, the Random Forest, Support Vector Machine, and Multilayer Perceptron algorithms were used to classify five tree species in Flanders (Belgium) with regularly spaced Sentinel-2 time series from 2018 to 2022. Cross-year single-year input scenarios were compared with same-year single-year input scenarios to quantify the temporal transferability of the five evaluated years. This resulted in a decrease in overall accuracy between 2.30 and 14.92 percentage points depending on the algorithm and evaluated year. Moreover, our results indicate that the cross-year classification performance could be improved by using multi-year training data, reducing the drop in overall accuracy. In some cases, gains in overall accuracy were even observed. This study highlights the importance of including interannual spectral variability during the training stage of tree species classification models to improve their ability to generalise in time. [ABSTRACT FROM AUTHOR]

Background: The long-term sustainability of arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT) remains a matter of debate. The primary aim of the present study was to assess the 10-year survival free from revision in ankles that had undergone arthroscopic BMS for an OLT. The secondary aim was to evaluate the influence of baseline patient and lesion characteristics on survival. Methods: Patients who underwent arthroscopic BMS for a symptomatic OLT and had a minimum follow-up of 10 years were included to assess procedure survival. The primary outcome, the 10-year cumulative survival rate, was analyzed by the Kaplan-Meier survival method. Secondary outcomes were the median time to revision and the effects of baseline factors (lesion size, primary or non-primary lesion type, preoperative cysts, and obesity as defined by a body mass index [BMI] of ≥30 kg/m²) on survival, analyzed with a Cox regression model and reported using hazard ratios (HRs). Results: The 262 included patients had a mean follow-up of 15.3 ± 4.8 years. The 10-year cumulative survival rate of the arthroscopic BMS procedures was 82% (95% confidence interval [CI]: 77% to 87%). At 15 years of follow-up, the cumulative survival rate was 82% (95% CI: 76% to 86%). The median time to revision was 2.4 years (interquartile range: 1.3 to 5.1 years). Of the baseline factors, obesity (HR: 3.0 [95% CI: 1.44 to 6.43], p < 0.01) was associated with decreased survival. Lesion size (HR: 0.9 [95% CI: 0.5 to 1.8], p = 0.8), non-primary lesion type (HR: 1.8 [95% CI: 0.9 to 3.4], p = 0.1), and the presence of preoperative cysts (HR: 1.0 [95% CI: 0.6 to 1.9], p = 0.9) were not significantly associated with survival. Conclusions: At a minimum follow-up of 10 years, the survival rate of arthroscopic BMS for OLT was 82%. At 15 and 20 years of follow-up, survival appeared to remain stable. Obesity (BMI ≥ 30 kg/m.²) was associated with a higher likelihood of revision surgery. This risk factor should be incorporated into the treatment algorithm for OLT when counseling patients regarding surgery. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence [ABSTRACT FROM AUTHOR]

Background: Post-intensive care syndrome (PICS), defined as physical, cognitive, and mental-health symptoms persisting long after intensive-care-unit (ICU) discharge, is increasingly recognised as a healthcare priority. Data on screening for PICS are sparse. Our objective here was to describe post-ICU screening in France, with special attention to visit availability and evaluations done during visits. Methods: We conducted an online multicentre survey by emailing an anonymous 43-item questionnaire to French ICUs. For each ICU, a single survey was sent to either the head or the intensivist in charge of follow-up visits. Results: Of 252 ICUs invited to participate, 161 (63.9%) returned the completed survey. Among them, 46 (28.6%) offered follow-up visits. Usually, a single visit led by an intensivist was scheduled 3 to 6 months after ICU discharge. Approximately 50 patients/year/ICU, that is, about 5% of admitted patients, attended post-ICU visits. The main criteria used to select patients for follow-up were ICU stay and/or invasive mechanical ventilation duration longer than 48 h, cardiac arrest, septic shock, and acute respiratory distress syndrome. Among ICUs offering visits, 80% used validated instruments to screen for PICS. Of the 115 ICUs not offering follow-up, 50 (43.5%) indicated an intention to start follow-up within the next year. The main barriers to offering follow-up were lack of available staff and equipment or not viewing PICS screening as a priority. Half the ICUs offering visits worked with an established network of post-ICU care professionals, and another 17% were setting up such a network. Obstacles to network creation were lack of interest among healthcare professionals and lack of specific training in PICS. Conclusion: Only a small minority of ICU survivors received follow-up designed to detect PICS. Less than a third of ICUs offered follow-up visits but nearly another third planned to set up such visits within the next year. Recommendations issued by French health authorities in 2023 can be expected to improve the availability and standardisation of post-ICU follow-up. [ABSTRACT FROM AUTHOR]

Background: Previous studies have produced conflicting results concerning the extent of magnitude representation deficit and its relationship with arithmetic achievement in children with 22q11.2 deletion syndrome. More specifically, it remains unclear whether deficits are restricted to visuospatial content or are more general and whether they could explain arithmetical impairment. Methods: Fifteen 5- to 12-year-old children with 22q11.2 deletion syndrome and 23 age-matched healthy controls performed a non-symbolic magnitude comparison task. Depending on the trial, participants had to compare stimuli with high or low visuospatial load (visuospatial stimuli or temporal sequence of visual stimuli). The participants also completed a battery of arithmetic skills (ZAREKI-R) and a battery of global cognitive functioning (WISC-V or WPPSI-IV), from which working memory and visuospatial indices were derived. Results: Children with 22q11.2DS responded as fast as healthy controls did but received fewer correct responses, irrespective of visuospatial load. In addition, their performance in the non-symbolic magnitude comparison task did not correlate with the ZAREKI total score, while the working memory index did. Conclusion: Children with 22q11.2DS might suffer from a global magnitude representation deficit rather than a specific deficit due to visuospatial load. However, this deficit alone does not seem to be related to arithmetic achievement. Working memory might be a better concern of interest in favoring arithmetic skills in patients with 22q11.2 deletion syndrome. Trial registration: Clinicaltrials, NCT04373226. Registered 16 September 2020. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) outcomes among patients with cirrhosis are poor, but factors associated with outcomes and provider awareness remain under-evaluated. Aims: We retrospectively investigated in-hospital CPR mortality among patients with cirrhosis, and, using these results, undertook an educational study among providers to improve knowledge of CPR outcomes and code status in patients with cirrhosis. Methods: We identified patients with cirrhosis admitted from 2012 to 2022 who underwent CPR at our center; the primary outcome was survival-to-discharge. A brief video based on these results was presented online to Internal Medicine residents, along with paired pre/post-surveys assessing attitudes toward holding code status conversations and knowledge of CPR outcomes in patients with cirrhosis. Results: 97 cases of CPR were identified. 27 patients (28%) survived to discharge post-CPR. A history of liver decompensation was significantly associated with lower survival (OR 0.21, p < 0.05). 22 residents participated in the educational intervention; afterward, their estimation of survival after CPR for patients with cirrhosis significantly improved (p < 0.05). Mean confidence in answering patient questions about prognosis, measured from 1 to 5, also significantly improved (2.4—"a little confident" vs. 3.8—"confident", p < 0.05). 59% of surveyed residents identified impact on liver transplant candidacy as at least a "somewhat significant" barrier to code status conversations. Conclusions: We identified significant trainee uncertainty about outcomes in patients with cirrhosis. These deficits improved after an educational intervention and gave providers more confidence in holding informed code status conversations with patients with cirrhosis, a population that faces barriers to adequate code discussions. [ABSTRACT FROM AUTHOR]

Background: Since late 2019, fortification of 'regular' cannabis plant material with synthetic cannabinoid receptor agonists (SCRAs) has become a notable phenomenon on the drug market. As many SCRAs pose a higher health risk than genuine cannabis, recognizing SCRA-adulterated cannabis is important from a harm reduction perspective. However, this is not always an easy task as adulterated cannabis may only be distinguished from genuine cannabis by dedicated, often expensive and time-consuming analytical techniques. In addition, the dynamic nature of the SCRA market renders identification of fortified samples a challenging task. Therefore, we established and applied an in vitro cannabinoid receptor 1 (CB1) activity-based procedure to screen plant material for the presence of SCRAs. Methods: The assay principle relies on the functional complementation of a split-nanoluciferase following recruitment of β-arrestin 2 to activated CB1. A straightforward sample preparation, encompassing methanolic extraction and dilution, was optimized for plant matrices, including cannabis, spiked with 5 µg/mg of the SCRA CP55,940. Results: The bioassay successfully detected all samples of a set (n = 24) of analytically confirmed authentic Spice products, additionally providing relevant information on the 'strength' of a preparation and whether different samples may have originated from separate batches or possibly the same production batch. Finally, the methodology was applied to assess the occurrence of SCRA adulteration in a large set (n = 252) of herbal materials collected at an international dance festival. This did not reveal any positives, i.e. there were no samples that yielded a relevant CB1 activation. Conclusion: In summary, we established SCRA screening of herbal materials as a new application for the activity-based CB1 bioassay. The simplicity of the sample preparation, the rapid results and the universal character of the bioassay render it an effective and future-proof tool for evaluating herbal materials for the presence of SCRAs, which is relevant in the context of harm reduction. [ABSTRACT FROM AUTHOR]

People's perceptions concerning radiation inform decision making in relation to nuclear power production. There have been extensive studies of people's perceptions of radiation including in relation to the Fukushima and Chernobyl nuclear events. This paper reports on a social science literature review study and is concerned with public responses to low dose radiation (LDR) and nuclear facilities, particularly in the marine environment. This review confirms that people with little knowledge about radiation have the highest risk perceptions in relation to nuclear power; conversely people with a broader knowledge have lower risk perceptions and are more favourable to nuclear power. Education can increase positive perceptions, but the influence of underlying experience of feeling, emotion, attachment, or mood may dampen this effect. This paper reports studies which document anxiety within the Japanese community in relation to the Fukushima nuclear accident. Literature concerning specific radionuclides released is described. While there are uncertainties about the presence of health impacts following LDR exposures, public attitudes are not in line. There is a need for better dialogue between nuclear professionals and scientists to achieve better nuclear education and public communication outcomes; more specific communication surrounding multi-isotopes, and multi-elements of nuclear power plant disaster releases is warranted. Trusted communicators should include nuclear and social scientists as well as regulators. Given the importance of decarbonization in the context of climate change, this is increasingly important. [ABSTRACT FROM AUTHOR]

Background: Traditional epidemiological evidence suggests various associations exist between alcohol and mental/cognitive health outcomes. However, whether these reflect causal relationships remains unclear. Mendelian randomization (MR) – a kind of instrumental variable analysis using genetic variants to proxy for an exposure of interest – has the potential to improve causal inference from observational data. Summary: In the first part of this review, the challenges of causal inference in the field are discussed, and a theoretical and practical introduction to the technique of MR is given. Next, we report on literature searches performed to update a previous systematic review of MR studies evaluating alcohol-mental health relationships. Twelve relevant studies were identified and considered in the context of the 22 studies included in the previous review. While the reviewed MR literature suggests possible causal relationships/a lack thereof, for the most part, the nature of causal relationships between alcohol and mental health remains unclear. Key Messages: MR is beginning to yield valuable insights into the causal effects of (problematic) alcohol consumption on mental and cognitive health outcomes. Future studies must be mindful of the technique's underlying assumptions and should allow for potential nonlinearity in relationships. Triangulating across sensitivity methods within MR studies, as well as between MR studies and other methods for enhanced causal inference, will be crucial. [ABSTRACT FROM AUTHOR]