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Purpose: To compare CDK4/6 inhibitor (CDK4/6i) with endocrine therapy (ET) in the first- versus second-line setting for treatment of hormone receptor positive (HR+), HER2 negative, metastatic breast cancer (MBC) using real-world evidence. Methods: Patients with HR+, HER2 negative MBC, diagnosed between 2/3/2015 and 11/2/2021 and having ≥ 3 months follow-up were identified from the nationwide electronic health record-derived Flatiron Health de-identified database. Treatment cohorts included: (1) first-line ET with a CDK 4/6i (1st-line CDK4/6i) versus (2) first-line ET alone followed by second-line ET with a CDK4/6i (2nd-line CDK4/6i). Differences in baseline characteristics were tested using chi-square tests and two-sample t-tests. Time to third-line therapy, time to start of chemotherapy, and overall survival were compared using Kaplan-Maier method. Results: The analysis included 2771 patients (2170 1st-line CDK4/6i and 601 2nd-line CDK4/6i). Patients receiving 1st-line CDK4/6i were younger (75% vs 68% < 75 years old, p = 0.0001), less likely uninsured or not having insurance status documented (10% vs. 13%, p = 0.04), of better performance status (50% vs 43% with ECOG 0, p = 0.03), and more likely to have de novo MBC (36% vs. 24%, p < 0.001). Time to third-line therapy (49 vs 22 months, p < 0.001) and time to chemotherapy (68 vs 41 months, p < 0.001) were longer in those receiving first-line CDK4/6i. Overall survival (54 vs 49 months, p = 0.33) was similar between groups. Conclusion: Use of CDK4/6i with first-, vs second-, line ET was associated with longer time to receipt of 3rd-line therapy and longer time to receipt of chemotherapy. [ABSTRACT FROM AUTHOR]

Objective: Electronic consultations (e-consults) provide a strategic solution to address challenges in health care systems related to cost management and access to care. This study aims to investigate the multilevel patient characteristics associated with higher frequency of receiving e-consults and increased likelihood of completion. Materials and Methods: University of Colorado's electronic medical record were analyzed to study factors influencing referral types (e-consult vs. standard) and their completion rates from April 2018 to September 2023. Multivariate probit regression assessed the impact of patient-level and community-level factors (urban–rural classification, Social Vulnerability Index, and technology accessibility) on e-consult referrals and completion. Results: In 263,882 records, 92.5% were standard referrals, and 7.4% were e-consult referrals. Analysis showed that females were less likely than males (OR = 0.95, 95%CI[0.93, 0.96]), and Blacks were more likely than Whites (OR = 1.03, 95%CI[1.01,1.06]) to receive e-consult referrals. Medicaid patients had lower odds compared to those with Medicare only (OR = 1.04, 95%CI[1.00,1.07]), and rural residency was associated with lower odds (OR = 0.80, 95%CI[0.73,0.88]) of e-consult referral. Factors such as areas with higher population without internet subscription (OR = 1.03, 95%CI[1.01,1.04]) and higher social vulnerabilities (OR = 1.26, 95%CI[1.16,1.37]) increased e-consult odds. Black patients were less likely to have their referrals completed compared to Whites. Patients who resided in regions with limited computer and smartphone access, as well as higher social vulnerabilities, showed decreased odds of referral completion. Discussions and Conclusion: This study highlights the need for partnering with a variety of health care organizations, especially those serving low-income and disadvantaged populations, to enhance health care access equity through the use of e-consults. [ABSTRACT FROM AUTHOR]

Objective: This study used real-world observational data to compare profiles of patients receiving different first-line treatment for hormone receptor positive (ER+), HER2 negative, metastatic breast cancer (MBC): CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) versus ET alone. Method: From a nationwide electronic health record-derived Flatiron Health de-identified database including 280 US cancer clinics, we identified patients with hormone receptor positive, HER2 negative, metastatic breast cancer receiving 1st -line therapy with ET alone or CDK4/6i plus ET between February 2015 and November 2021. Patient sociodemographic status, MBC treatment regimen and outcomes were the focus of this analysis. Patient characteristics were compared using t-tests and chi-square tests. Logistic regression analysis was performed to examine the association of patient characteristics with the likelihood of receiving 1st -line CDK4/6i plus ET vs. ET alone. Kaplan-Meier method and Cox proportional hazards were used to test the impact of 1st -line treatment regimen on real-world progression-free survival (PFS) and overall survival (OS). Baseline characteristics were balanced using inverse probability weighting (IPW). Results: The study population included 3,917 patients receiving CDK4/6i plus ET (n = 2170) and ET alone (n = 1747) for their MBC. Compared to patients receiving ET alone, those receiving CDK4/6i plus ET were younger (mean age 66.8 vs. 68.6, p < 0.001), more likely to present with de novo MBC (p < 0.001), had better performance status (50.2% vs. 40.5% patients with ECOG value 0, p = 0.001) and lower number of comorbidities (29.7% vs. 26.6% ≥ 1 comorbidity, p < 0.001). Logistic regression revealed increased odds of CDK4/6i plus ET in individuals aged 50–64 (OR: 3.42, 95% CI [2.41, 4.86]) and 65–74 (OR: 3.18, 95% CI [1.68, 6.02]) versus those aged 18–49 years of age. Black individuals had lower odds of CDK4/6i plus ET (OR: 0.76, 95% CI [0.58, 1.00]) compared to White individuals. Other characteristics associated with lower odds of CDK4/6i plus ET included patients with stage III disease (OR: 0.69, 95% CI [0.52, 0.92]), lower performance status (OR: 0.50, 95% CI [0.40, 0.62]), and Medicare insurance (OR: 0.73, 95% CI [0.30, 1.78]) compared to those with commercial and Medicaid insurance. After IPW adjustment, use of CDK4/6i plus ET as 1st -line treatment was associated with significantly longer median PFS compared to ET alone (27 vs. 17 months; hazard ratio [HR] = 0.61, p < 0.001). Median OS was 52 months in the CDK4/6i plus ET group and was 42 months with ET alone (HR = 0.74, p < 0.001). Conclusion: In this real-world database, disparities in receiving 1st -line CDK4/6 inhibitors were seen by age, diagnosis stage, baseline performance status, comorbidity, and insurance status. In adjusted analysis, the use of 1st -line CDK4/6i plus ET yielded better PFS and OS rates than ET alone. Further efforts are essential to enhance equitable use of and access to this crucial drug class. [ABSTRACT FROM AUTHOR]

The implementation of school-based obesity-prevention programs is understudied. Kids SIP smart ER is a 6-month, school-based, behavioral intervention for Appalachian middle school students and includes a teacher implementation strategy. Kids SIP smart ER effectively reduced students' sugar-sweetened beverages (SSB) when Researcher-Led. However, Teacher-Led effectiveness and fidelity are unknown. To explore the relative SSB effects when Kids SIP smart ER was Researcher-Led versus Teacher-Led and to examine teacher fidelity. This study of secondary outcomes used a quasi-experimental analytic approach of a Hybrid Type 1 effectiveness–implementation and cluster randomized controlled tria (RCT) of Kids SIP smart ER. Student SSB behaviors and teacher self-rated fidelity were assessed, respectively, with the validated Beverage Intake Questionnaire (BEVQ-15) and lesson-specific checklists. Analyses included descriptive statistics and modified two-part models with time-fixed effects and school-year cohort cluster controls. The analytic sample included students from six control schools (n = 220), six Researcher-Led intervention schools (n = 306), and five Teacher-Led intervention schools (n = 218), as well as eight teachers. Teacher-Led intervention students decreased SSB by −14.3 ounces/day (95% confidence interval = −15.4, −13.2; P <.001). Relative to control and to Researcher-Led intervention, the Teacher-Led treatment effect among students was −11.6 ounces SSB/day (P <.001, effect size = 0.75) and −4.3 (P =.004, effect size = 0.25), respectively. Teachers returned fidelity checklists for 90% of planned lessons. Fidelity averaged 94% (SD = 4.0%) among returned forms and 85% (SD = 18.9%) when missing forms were counted as zeros. Teachers can implement Kids SIP smart ER with high fidelity and produce statistically and clinically meaningful improvements in students' SSB behaviors. Findings have implications for the sustained implementation of Kids SIP smart ER and other school-based obesity-prevention programs. Clinical Trial information : NCT03740113. [ABSTRACT FROM AUTHOR]

Background Delivering insomnia treatment by the Internet holds promise for increasing care access to family caregivers, but their ability to adhere to and benefit from such fully-automated programs has not been rigorously tested. Purpose This fully-powered, single-group trial tested whether characteristics of the caregiving context influence high-intensity caregivers' engagement with and benefit from an empirically validated Internet intervention for insomnia. Methods At baseline, caregivers providing unpaid time- and responsibility-intensive care who reported insomnia (N = 100; age M = 52.82 [ SD = 13.10], 75% non-Hispanic white, 66% ≥college degree) completed questionnaires about caregiving context and sleep, then 10 prospectively-collected online daily sleep diaries. Caregivers then received access to SHUTi (Sleep Healthy Using the Internet), which has no caregiver-specific content, for 9 weeks, followed by post-assessment (questionnaires, diaries). Engagement was tracked by the SHUTi delivery system. Results Sixty caregivers completed SHUTi, 22 initiated but did not complete SHUTi, and 18 did not initiate SHUTi. Caregivers were more likely to use SHUTi (than not use SHUTi) when their care recipient (CR) had worse functioning, and were more likely to complete SHUTi when supporting more CR activities of daily living (ADL; p s < .03). Higher caregiver guilt, more CR problem behaviors, and being bedpartners with the CR related to more improved sleep outcomes, whereas supporting more CR instrumental ADL related to less improvement (p s < .05). Conclusions Factors associated with greater caregiving burden, including greater CR impairment and caregiving guilt, were generally associated with better engagement and outcomes. Caregivers with substantial burdens can adhere to and benefit from a fully automated insomnia program without caregiver-specific tailoring. [ABSTRACT FROM AUTHOR]

Background: Peptide transporter 1 (PepT1) transports bacterial oligopeptide products and induces inflammation of the bowel. Nutritional peptides compete for the binding of intestinal bacterial products to PepT1. We investigated the mechanism of short-peptide-based enteral nutrition (SPEN) on the damage to the gut caused by the bacterial oligopeptide product muramyl dipeptide (MDP), which is transported by PepT1. The gut-lung axis is a shared mucosal immune system, and immune responses and disorders can affect the gut-respiratory relationship. Methods and results: Sprague-Dawley rats were gavaged with solutions containing MDP, MDP + SPEN, MDP + intact-protein-based enteral nutrition (IPEN), glucose as a control, or glucose with GSK669 (a NOD2 antagonist). Inflammation, mitochondrial damage, autophagy, and apoptosis were explored to determine the role of the PepT1-nucleotide-binding oligomerization domain-containing protein 2 (NOD2)-beclin-1 signaling pathway in the small intestinal mucosa. MDP and proinflammatory factors of lung tissue were explored to determine that MDP can migrate to lung tissue and cause inflammation. Induction of proinflammatory cell accumulation and intestinal damage in MDP gavage rats was associated with increased NOD2 and Beclin-1 mRNA expression. IL-6 and TNF-α expression and apoptosis were increased, and mitochondrial damage was severe, as indicated by increased mtDNA in the MDP group compared with controls. MDP levels and expression of proinflammatory factors in lung tissue increased in the MDP group compared with the control group. SPEN, but not IPEN, eliminated these impacts. Conclusions: Gavage of MDP to rats resulted in damage to the gut-lung axis. SPEN reverses the adverse effects of MDP. The PepT1-NOD2-beclin-1 pathway plays a role in small intestinal inflammation, mitochondrial damage, autophagy, and apoptosis. [ABSTRACT FROM AUTHOR]

We describe a high-performance molecular iodine optical frequency reference that is referenced to the R(56)32-0: a1 hyperfine transition of molecular iodine based on modulation transfer spectroscopy. We design an unsaturated iodine vapor cell with a gas pressure equivalent to the saturation pressure at −17 °C. Using this cell, we developed a compact, frequency-stabilized laser. The iodine cell operates at room temperature and is not actively temperature stabilized. We demonstrate a laser with fractional frequency instability of 1.4 × 10−14 at 1 s and 1.7 × 10−15 at 104 s. To our knowledge, the level of frequency instability at 104 s is comparable to the previously reported best results for an iodine stabilized laser. These results suggest that using an unsaturated iodine vapor cell is a valid approach for the development of long-term, stable iodine-based optical references. [ABSTRACT FROM AUTHOR]

The specific process of hydrogen generation by the reaction of In7 and In6Al clusters with H2O molecules is explored through density functional theory in this study. Based on the prediction of the lowest energy structure of In7 and In6Al clusters, the geometric and electronic structures of In7@H2O and In6Al@H2O are obtained by using the dispersion-corrected density functional theory B3LYP-D3. The corresponding reaction paths are constructed according to the transition states in the searched reactions. Then we discuss the reaction path, energy barrier and reaction energy release. The results show that both In7 and In6Al clusters can react with H2O molecules and release hydrogen. Both reactions are exothermic reactions, and the structure of the reaction product are very similar. The comparison of adsorption energy, energy barrier and reaction release energy show that the Al-doped In7 cluster can significantly improve its ability to react with H2O and reduce the energy barrier that has to be overcome for the reaction process. The generated H2 exists on the cluster surface in the form of physical adsorption, which is judged by the adsorption energy, the distance between the H2 molecule and the cluster surface, and the interaction region indicator (IRI). [ABSTRACT FROM AUTHOR]

In this article, we study the optimized structures, spin crossover, and coherent quantum transport properties of a series of cyclopentadienyl metalloporphyrin (PTMCp, TM = transition metal) complexes using the density functional theory combined with the non-equilibrium Green's function method. The structure of the complexes can be classified into the sandwich type and the biplanar type. Energetic analyses of spin states reveal that the IS(intermediate-spin)-HS(high-spin) spin transition may appear in PMnCp and PFeCp, and the LS(low-spin)-IS(intermediate-spin)-HS(high-spin) two-step spin transition may appear in PCoCp under external stimulus. We predict that giant magnetoresistance may be observed in the ground-state sandwich PTMCp depending on the contact between the electrodes and the molecule in measurements. These results indicate that PTMCp complexes could be promising materials for spintronics. [ABSTRACT FROM AUTHOR]

Based on the quantum coherence theory, we employ the l 1 -norm measure to explore the steady-state coherence (SSC) in the spin-boson model. In this model, the environment is a non-Markovian bosonic bath with Ohmic-like spectral density. More generally, the interaction coupling between the qubit and the environment is a linear superposition of pure dephasing and pure damping coupling. Governed by the non-Markovian dynamics, some compact expressions of the SSC have been obtained at both zero temperature and high temperature. It shows that the hybrid coupling significantly affects the SSC. Moreover, a comprehensive analysis has been conducted to investigate the effects of various crucial factors, including the temperature of the bosonic bath, the qubit's tunneling and the Ohmicity parameter. This analysis provides an effective approach for maintaining a relatively high SSC by manipulating system parameters. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine the prevalence of overweight/obesity and excessive gestational weight gain (GWG) among military beneficiaries and to assess associations of these risk factors with maternal/neonatal complications and substantial postpartum weight retention (PPWR). Methods: We obtained data for 48,391 TRICARE beneficiaries who gave birth in 2018 or 2019 in the United States. We used logistic regression and ANOVA to examine relationships among overweight/obesity, GWG, maternal/neonatal complications, and substantial PPWR. Results: Most TRICARE beneficiaries (75%) had excessive GWG, and 42% had substantial PPWR. Dependents were less likely than active‐duty women to have excessive GWG (odds ratio [OR] = 0.73, 95% CI: 0.60–0.88). Women with excessive GWG were three times more likely to have substantial PPWR (OR = 3.57, 95% CI: 3.14–4.06). Those with excessive GWG were more likely to have maternal/neonatal complications (e.g., pregnancy‐induced hypertension, cesarean delivery). Conclusions: Excessive GWG is frequent among TRICARE beneficiaries, particularly active‐duty personnel, and is strongly associated with costly maternal/neonatal complications. Substantial PPWR is also common in this population, with excessive GWG as a key risk factor. [ABSTRACT FROM AUTHOR]

Background: High consumption of sugar-sweetened beverages (SSB) is a global health concern. Additionally, sugar-sweetened beverage (SSB) consumption is disproportionately high among adolescents and adults in rural Appalachia. The primary study objective is to determine the intervention effects of Kids SIPsmartER on students' SSB consumption. Secondary objectives focus on caregivers' SSB consumption and secondary student and caregiver outcomes [e.g, body mass index (BMI), quality of life (QOL)]. Methods: This Type 1 hybrid, cluster randomized controlled trial includes 12 Appalachian middle schools (6 randomized to Kids SIPsmartER and 6 to control). Kids SIPsmartER is a 6-month, 12 lesson, multi-level, school-based, behavior and health literacy program aimed at reducing SSB among 7th grade middle school students. The program also incorporates a two-way text message strategy for caregivers. In this primary prevention intervention, all 7th grade students and their caregivers from participating schools were eligible to participate, regardless of baseline SSB consumption. Validated instruments were used to assess SSB behaviors and QOL. Height and weight were objectively measured in students and self-reported by caregivers. Analyses included modified two-part models with time fixed effects that controlled for relevant demographics and included school cluster robust standard errors. Results: Of the 526 students and 220 caregivers, mean (SD) ages were 12.7 (0.5) and 40.6 (6.7) years, respectively. Students were 55% female. Caregivers were mostly female (95%) and White (93%); 25% had a high school education or less and 33% had an annual household income less than $50,000. Regardless of SSB intake at baseline and relative to control participants, SSB significantly decreased among students [-7.2 ounces/day (95% CI = -10.7, -3.7); p < 0.001, effect size (ES) = 0.35] and caregivers [-6.3 ounces/day (95% CI = -11.3, -1.3); p = 0.014, ES = 0.33]. Among students (42%) and caregivers (28%) who consumed > 24 SSB ounces/day at baseline (i.e., high consumers), the ES increased to 0.45 and 0.95, respectively. There were no significant effects for student or caregiver QOL indicators or objectively measured student BMI; however, caregiver self-reported BMI significantly decreased in the intervention versus control schools (p = 0.001). Conclusions: Kids SIPsmartER was effective at reducing SSB consumption among students and their caregivers in the rural, medically underserved Appalachian region. Importantly, SSB effects were even stronger among students and caregivers who were high consumers at baseline. Trial registration: Clincialtrials.gov: NCT03740113. Registered 14 November 2018– Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03740113. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to analyze the clinical characteristics of Chinese children with spinal cord injury (SCI) without radiographic abnormality (SCIWORA) and explore their contributing factors and mechanisms of occurrence. Methods: A retrospective analysis was conducted on the clinical data of pediatric patients diagnosed with SCIWORA from January 2005 to May 2020. Epidemiological, etiological, mechanistic, therapeutic, and outcome aspects were analyzed. Results: A total of 47 patients with SCIWORA were included in this study, comprising 16 males and 31 females. The age range was 4 to 12 years, with an average age of 7.49 ± 2.04 years, and 70% of the patients were below eight. Sports-related injuries constituted 66%, with 70% attributed to dance backbend practice. Thoracic segment injuries accounted for 77%. In the American Spinal Injury Association (ASIA) classification, the combined proportion of A and B grades accounted for 88%. Conservative treatment was chosen by 98% of the patients, with muscle atrophy, spinal scoliosis, hip joint abnormalities, and urinary system infections being the most common complications. Conclusion: SCIWORA in Chinese children is more prevalent in those under eight years old, with a higher incidence in females than males. Thoracic spinal cord injuries are predominant, dance backbend as a primary contributing factor, and the social environment of "neijuan" is a critical potential inducing factor. Furthermore, the initial severity of the injury plays a decisive role in determining the prognosis of SCIWORA. [ABSTRACT FROM AUTHOR]

This study explores the potential efficacy of chlorogenic acid (CGA) in mitigating lipopolysaccharide (LPS)-induced cystitis in a mice model. C57BL/6J mice were divided into four groups: normal control (NC), LPS, LPS + low CGA, and LPS + high CGA. Evaluation methods included cystometrogram (CMG), histopathological, western blot, and immunohistological analysis. In the LPS group, CMG revealed abnormal voiding behavior with increased micturition pressure, voided volume (VV), and decreased voided frequency. Low CGA treatment in LPS mice demonstrated improved micturition pressure and inter-contraction intervals (ICI). However, high CGA treatment exhibited prolonged ICI and increased VV, suggesting potential adverse effects. Histological analysis of LPS-treated mice displayed bladder inflammation and interstitial edema. Low CGA treatment reduced interstitial edema and bladder inflammation, confirmed by Masson's trichrome staining. Western blotting revealed increased cytokeratin 20 (K20) expression in the low CGA group, indicating structural abnormalities in the bladder umbrella layer after LPS administration. In conclusion, low CGA treatment positively impacted voiding behavior and decreased bladder edema and inflammation in the LPS-induced cystitis mice model, suggesting its potential as a supplement for inflammation cystitis prevention. However, high CGA treatment exhibited adverse effects, emphasizing the importance of dosage considerations in therapeutic applications. [ABSTRACT FROM AUTHOR]

Objectives: We conducted a comprehensive meta-analysis to compare the effectiveness and safety of fluoroscopy-guided air enema reduction (FGAR) and ultrasound-guided hydrostatic enema reduction (UGHR) for the treatment of intussusception in pediatric patients. Methods: A systematic review and meta-analysis were conducted on retrospective studies obtained from various databases, including PUBMED, MEDLINE, Cochrane, Google Scholar, China National Knowledge Infrastructure (CNKI), WanFang, and VIP Database. The search included publications from January 1, 2003, to March 31, 2023, with the last search done on Jan 15, 2023. Results: We included 49 randomized controlled studies and retrospective cohort studies involving a total of 9,391 patients, with 4,841 in the UGHR and 4,550 in the FGAR. Specifically, UGHR exhibited a significantly shorter time to reduction (WMD = -4.183, 95% CI = (-5.402, -2.964), P < 0.001), a higher rate of successful reduction (RR = 1.128, 95% CI = (1.099, 1.157), P < 0.001), and a reduced length of hospital stay (WMD = -1.215, 95% CI = (-1.58, -0.85), P < 0.001). Furthermore, UGHR repositioning was associated with a diminished overall complication rate (RR = 0.296, 95% CI = (0.225, 0.389), P < 0.001) and a lowered incidence of perforation (RR = 0.405, 95% CI = (0.244, 0.670), P < 0.001). Conclusion: UGHR offers the benefits of being non-radioactive, achieving a shorter reduction time, demonstrating a higher success rate in repositioning in particular, resulting in a reduced length of postoperative hospital stay, and yielding a lower overall incidence of postoperative complications, including a reduced risk of associated perforations. [ABSTRACT FROM AUTHOR]

The effects of key parameters on locked mode induced disruption (LMiD) are investigated in EAST experiments. The experimental data for locked mode are collected from 2015 to 2022 when the externally applied resonant magnetic perturbation is successfully employed in EAST. In this dataset, ∼42% of the total shots are LMiD, while the remaining 58% are LM without disruption. To better analyze the LMiD, an intuitive physical process is proposed. The LMiD process can be divided into two stages, the evolution of magnetic islands and the loss of plasma stored energy. The LMiD can also be related to the evolution of the other 8 physical quantities. On the basis of this physical process analysis, the time scale and the influencing factors for LMiD are investigated using statistical analysis. It is found that the density (ne), the distance from the magnetic island outer boundary to the plasma last closed surface (dedge), the loop-voltage (Vloop), and the plasma core electron temperature (Te), which are consistent with the intuitive physical model, are key parameters to LMiD. In addition, other potentially important parameters, the relevant reasons, and statistical analysis on the parameter intervals where rapid disruption with greater harmfulness occurred have also been investigated. [ABSTRACT FROM AUTHOR]

Background: Cognitive‐behavioral therapy for insomnia (CBT‐I) is considered the gold standard treatment for insomnia. Prior trials have delivered CBT‐I across a range of treatment sessions. Understanding the economics of varying treatment approaches is essential for future implementation considerations. Methods: We conducted a retrospective cost‐effectiveness analysis from the provider's perspective, comparing the implementation of a three‐session CBT‐I program for cancer survivors (CBT‐I‐CS) versus a stepped care treatment approach consisting of an initial single sleep education session followed by CBT‐I‐CS if elevated insomnia symptoms persisted. The effectiveness measure used was the percentage of participants whose insomnia had remitted by the end of each program. Results: Stepped care delivery was more effective than CBT‐I‐CS alone, resulting in 35.4% more remitted patients by the end of the overall program. For a $480 willingness to pay threshold per percentage of remitted patients, stepped care CBT‐I‐CS reached a 98% probability of being cost‐effective, while CBT‐I‐CS alone had only a 2% probability. Larger group sessions in the first step of a stepped care delivery model resulted in more favorable cost‐effectiveness. Conclusions: A stepped care delivery model may be a more cost‐effective approach if it can be implemented efficiently. These findings inform policies aimed at improving cancer survivors' access to much‐needed insomnia treatment in settings where financial resources for CBT‐I may be limited, and be an important barrier to treatment dissemination. Clinical Trial Registration: These analyses were not registered. [ABSTRACT FROM AUTHOR]

Background: Adult smoking rates in the USA are highest in economically depressed rural Appalachia. Pharmacist-delivered tobacco cessation support that incorporates medication therapy management (such as the QuitAid intervention) is a promising approach to address this need. Methods: Twenty-four adult smokers recruited between September and November 2021 through an independent pharmacy in rural Appalachia were randomized in a non-blinded 2 × 2 × 2 factorial design to (1) pharmacist delivered QuitAid intervention (yes vs. no); (2) combination nicotine replacement therapy (NRT) gum + NRT patch (vs. NRT patch); and/or (3) 8 weeks of NRT (vs. standard 4 weeks). Participants received 4 weeks of NRT patch in addition to the components to which they were assigned. Participants completed baseline and 3-month follow-up assessments. Primary outcomes were feasibility of recruitment and randomization, retention, treatment adherence, and fidelity. Results: Participants were recruited in 7 weeks primarily through a referral process, commonly referred to as ask-advise-connect (61%). Participants were on average 52.4 years old, 29.2% were male and the majority were white (91.6%) and Non-Hispanic (91.7%). There was a high level of adherence to the interventions, with 85% of QuitAid sessions completed, 83.3% of the patch used, and 54.5% of gum used. Participants reported a high level of satisfaction with the program, and there was a high level of retention (92%). Conclusions: This demonstration pilot randomized controlled study indicates that an ask-advise-connect model for connecting rural smokers to smoking cessation support and providing QuitAid for smoking cessation is feasible and acceptable among rural Appalachian smokers and independent pharmacists. Further investigation into the efficacy of a pharmacist-delivered approach for smoking cessation is needed. Trial registration: The trial was retrospectively registered at ClinicalTrials.gov. Trial #: NCT05649241. [ABSTRACT FROM AUTHOR]

The elimination of cancer cells critically depends on the immune system. However, cancers have evolved a variety of defense mechanisms to evade immune monitoring, leading to tumor progression. Complement factor H (CFH), predominately known for its function in inhibiting the alternative pathway of the complement system, has recently been identified as an important innate immunological checkpoint in cancer. CFH-mediated immunosuppression enhances tumor cells' ability to avoid immune recognition and produce an immunosuppressive tumor microenvironment. This review explores the molecular underpinnings, interactions with immune cells, clinical consequences, and therapeutic possibilities of CFH as an innate immune checkpoint in cancer control. The difficulties and opportunities of using CFH as a target in cancer immunotherapy are also explored. [ABSTRACT FROM AUTHOR]

Purpose: To investigate potential differences in pathological complete response (pCR) rates and overall survival (OS) between HER2-low and HER2-zero patients with early-stage hormone receptor (HR)-positive and triple-negative breast cancer (TNBC), in the neoadjuvant chemotherapy setting. Methods: We identified early-stage invasive HER2-negative BC patients who received neoadjuvant chemotherapy diagnosed between 2010 and 2018 in the National Cancer Database. HER2-low was defined by immunohistochemistry (IHC) 1+ or 2+ with negative in situ hybridization, and HER2-zero by IHC0. All the methods were applied separately in the HR-positive and TNBC cohorts. Logistic regression was used to estimate the association of HER2 status with pCR (i.e. ypT0/Tis and ypN0). Kaplan–Meier method and Cox proportional hazards model were applied to estimate the association of HER2 status with OS. Inverse probability weighting and/or multivariable regression were applied to all analyses. Results: For HR-positive patients, 70.9% (n = 17,934) were HER2-low, whereas 51.1% (n = 10,238) of TNBC patients were HER2-low. For both HR-positive and TNBC cohorts, HER2-low status was significantly associated with lower pCR rates [HR-positive: 5.0% vs. 6.7%; weighted odds ratio (OR) = 0.81 (95% CI: 0.72–0.91), p < 0.001; TNBC: 21.6% vs. 24.4%; weighted OR = 0.91 (95% CI: 0.85–0.98), p = 0.007] and improved OS [HR-positive: weighted hazard ratio = 0.85 (95% CI: 0.79–0.91), p < 0.001; TNBC: weighted hazard ratio = 0.91 (95% CI: 0.86–0.96), p < 0.001]. HER2-low status was associated with favorable OS among patients not achieving pCR [HR-positive: adjusted hazard ratio = 0.83 (95% CI: 0.77–0.89), p < 0.001; TNBC: adjusted hazard ratio = 0.88 (95% CI 0.83–0.94), p < 0.001], while no significant difference in OS was observed in patients who achieved pCR [HR-positive: adjusted hazard ratio = 1.00 (95% CI: 0.61–1.63), p > 0.99; TNBC: adjusted hazard ratio = 1.11 (95% CI: 0.85–1.45), p = 0.44]. Conclusion: In both early-stage HR-positive and TNBC patients, HER2-low status was associated with lower pCR rates. HER2-zero status might be considered an adverse prognostic factor for OS in patients not achieving pCR. [ABSTRACT FROM AUTHOR]

Background: Cronkhite-Canada syndrome (CCS) is a rare, nonhereditary disease characterized by diffuse gastrointestinal polyposis and ectodermal abnormalities. Although it has been proposed to be a chronic inflammatory condition, direct evidence of its pathogenesis is lacking. This study aims to investigate the pathophysiology of CCS by analyzing transcriptomic changes in the colonic microenvironment. Methods: Next-generation sequencing-based genome-wide transcriptional profiling was performed on colonic hamartomatous polyps from four CCS patients and normal colonic mucosa from four healthy volunteers. Analyses of differential expression and multiple enrichment analyses were conducted from the molecular level to the cellular level. Quantitative real-time PCR (qRT-PCR) was carried out to validate the sequencing accuracy in samples from six CCS patients and six healthy volunteers. Results: A total of 543 differentially expressed genes were identified, including an abundance of CC- and CXC-chemokines. Innate immune response-related pathways and processes, such as leukocyte chemotaxis, cytokine production, IL-17, TNF, IL-1 and NF-kB signaling pathways, were prominently enhanced in CCS colonic polyps. Upregulation of wound healing, epithelial-mesenchymal transition, Wnt, and PI3K-Akt signaling pathways were also observed. Enrichment analyses at different levels identified extracellular structure disorganization, dysfunction of the gut mucosal barrier, and increased angiogenesis. Validation by qRT-PCR confirmed increased expression of the LCN2, IL1B, CXCL1, and CXCL3 genes in CCS colonic polyps. Conclusions: This case-control whole transcriptome analysis of active CCS colonic hamartomatous polyps revealed intricate molecular pathways, emphasizing the role of the innate immune response, extracellular matrix disorganization, inflammatory cell infiltration, increased angiogenesis, and potential epithelial to mesenchymal transition. These findings supports CCS as a chronic inflammatory condition and sheds light on potential therapeutic targets, paving the way for more effective and personalized management of CCS in the future. [ABSTRACT FROM AUTHOR]

Purpose: To investigate potential differences in pathological complete response (pCR) rates and overall survival (OS) between HER2-low and HER2-zero patients with early-stage hormone receptor (HR)-positive and triple-negative breast cancer (TNBC), in the neoadjuvant chemotherapy setting. Methods: We identified early-stage invasive HER2-negative BC patients who received neoadjuvant chemotherapy diagnosed between 2010 and 2018 in the National Cancer Database. HER2-low was defined by immunohistochemistry (IHC) 1+ or 2+ with negative in situ hybridization, and HER2-zero by IHC0. All the methods were applied separately in the HR-positive and TNBC cohorts. Logistic regression was used to estimate the association of HER2 status with pCR (i.e. ypT0/Tis and ypN0). Kaplan–Meier method and Cox proportional hazards model were applied to estimate the association of HER2 status with OS. Inverse probability weighting and/or multivariable regression were applied to all analyses. Results: For HR-positive patients, 70.9% (n = 17,934) were HER2-low, whereas 51.1% (n = 10,238) of TNBC patients were HER2-low. For both HR-positive and TNBC cohorts, HER2-low status was significantly associated with lower pCR rates [HR-positive: 5.0% vs. 6.7%; weighted odds ratio (OR) = 0.81 (95% CI: 0.72–0.91), p < 0.001; TNBC: 21.6% vs. 24.4%; weighted OR = 0.91 (95% CI: 0.85–0.98), p = 0.007] and improved OS [HR-positive: weighted hazard ratio = 0.85 (95% CI: 0.79–0.91), p < 0.001; TNBC: weighted hazard ratio = 0.91 (95% CI: 0.86–0.96), p < 0.001]. HER2-low status was associated with favorable OS among patients not achieving pCR [HR-positive: adjusted hazard ratio = 0.83 (95% CI: 0.77–0.89), p < 0.001; TNBC: adjusted hazard ratio = 0.88 (95% CI 0.83–0.94), p < 0.001], while no significant difference in OS was observed in patients who achieved pCR [HR-positive: adjusted hazard ratio = 1.00 (95% CI: 0.61–1.63), p > 0.99; TNBC: adjusted hazard ratio = 1.11 (95% CI: 0.85–1.45), p = 0.44]. Conclusion: In both early-stage HR-positive and TNBC patients, HER2-low status was associated with lower pCR rates. HER2-zero status might be considered an adverse prognostic factor for OS in patients not achieving pCR. [ABSTRACT FROM AUTHOR]

Despite advancements in analytical technologies, the complex nature of cosmetic matrices, coupled with the presence of diverse and trace unauthorized additives, hinders the application of these technologies in cosmetics analysis. This not only impedes effective regulation of cosmetics but also leads to the continual infiltration of illegal products into the market, posing serious health risks to consumers. The establishment of cosmetic regulations is often based on extensive scientific experiments, resulting in a certain degree of latency. Therefore, timely advancement in laboratory research is crucial to ensure the timely update and adaptability of regulations. A comprehensive understanding of the composition of cosmetic matrices and their pretreatment technologies is vital for enhancing the efficiency and accuracy of cosmetic detection. Drawing upon the China National Medical Products Administration's 2021 Cosmetic Classification Rules and Classification Catalogue, we streamline the wide array of cosmetics into four principal categories based on the following compositions: emulsified, liquid, powdered, and wax-based cosmetics. In this review, the characteristics, compositional elements, and physicochemical properties inherent to each category, as well as an extensive overview of the evolution of pretreatment methods for different categories, will be explored. Our objective is to provide a clear and comprehensive guide, equipping researchers with profound insights into the core compositions and pretreatment methods of cosmetics, which will in turn advance cosmetic analysis and improve detection and regulatory approaches in the industry. [ABSTRACT FROM AUTHOR]

In this paper, a novel air bleeding aerodynamic diffuser is proposed based on the study of the traditional dump diffuser. The performance and flow characteristics of these two diffusers are compared and analyzed using the numerical simulation method, which is validated by experiments. The effects of length and hole diameter on the diffuser's performance are also studied. The results reveal that, at inlet Mach numbers of 0.15, 0.20 and 0.30, compared with the dump diffuser, the total pressure loss coefficient of the new diffuser decreases by 18.52 %, 15.05 % and 40.23 %. The performance of the air bleeding aerodynamic diffuser with varing lengths has little change, which means its aerodynamic capabilities are still capable of meeting the requirements of advanced combustion chambers. As the diameter of the air bleed hole increases, the total pressure loss coefficient of the diffuser decreases and becomes gentler. [ABSTRACT FROM AUTHOR]

Bcl2l1 (Bcl-XL) belongs to the Bcl-2 family, Bcl2 and Bcl2-XL are major anti-apoptotic proteins, and the apoptosis of osteoblasts is a key event for bone homeostasis. As the functions of Bcl2l1 in osteoblasts and bone homeostasis remain unclear, we generated osteoblast-specific Bcl2l1-deficient (Bcl2l1fl/flCre) mice using 2.3-kb Col1a1 Cre. Trabecular bone volume and the trabecular number were lower in Bcl2l1fl/flCre mice of both sexes than in Bcl2l1fl/fl mice. In bone histomorphometric analysis, osteoclast parameters were increased in Bcl2l1fl/flCre mice, whereas osteoblast parameters and the bone formation rate were similar to those in Bcl2l1fl/fl mice. TUNEL-positive osteoblastic cells and serum TRAP5b levels were increased in Bcl2l1fl/flCre mice. The deletion of Bcl2l1 in osteoblasts induced Tnfsf11 expression, whereas the overexpression of Bcl-XL had no effect. In a co-culture of Bcl2l1-deficient primary osteoblasts and wild-type bone-marrow-derived monocyte/macrophage lineage cells, the numbers of multinucleated TRAP-positive cells and resorption pits increased. Furthermore, serum deprivation or the deletion of Bcl2l1 in primary osteoblasts increased apoptosis and ATP levels in the medium. Therefore, the reduction in trabecular bone in Bcl2l1fl/flCre mice may be due to enhanced bone resorption through osteoblast apoptosis and the release of ATP from apoptotic osteoblasts, and Bcl2l1 may inhibit bone resorption by preventing osteoblast apoptosis. [ABSTRACT FROM AUTHOR]

Background: Existing financial hardship screening does not capture the multifaceted and dynamic nature of the problem. The use of existing health system data is a promising way to enable scalable and sustainable financial hardship screening. Methods: We used existing data from 303 adult patients with cancer at the University of Virginia Comprehensive Cancer Center (2016–2018). All received distress screening and had a valid financial assistance screening based solely on household size‐adjusted income. We constructed a composite index that integrates multiple existing health system data (Epic, distress screening, and cancer registry) to assess comprehensive financial hardship (e.g., material conditions, psychological responses, and coping behaviors). We examined differences of at‐risk patients identified by our composite index and by existing single‐dimension criterion. Dynamics of financial hardship over time, by age, and cancer type, were examined by fractional probit models. Results: At‐risk patients identified by the composite index were generally younger, better educated, and had a higher annual household income, though they had lower health insurance coverage. Identified periods to intervene for most patients are before formal diagnosis, 2 years, and 6 years after diagnosis. Within 2 years of diagnosis and more than 4 years after diagnosis appear critical for subgroups of patients who may suffer from financial hardship disparities. Conclusion: Existing health system data provides opportunities to systematically measure and track financial hardship in a systematic, scalable and sustainable way. We find that the dimensions of financial hardship can exhibit different patterns over time and across patient subgroups, which can guide targeted interventions. The scalability of the algorithm is limited by existing data availability. [ABSTRACT FROM AUTHOR]

Mixed harmonic resonant magnetic perturbations (RMPs) for integrated edge localized modes (ELMs) and divertor flux control are demonstrated in EAST target plasmas of low input torque and normalized beta β N ∼ 1.7–1.9, which are close to the equivalent value in ITER high Q operation. The applied RMPs are designed to combine a static harmonic of the toroidal mode number n = 3 with a static or rotating harmonic of n = 2. ELM suppression is achieved without a drop of plasma energy confinement, and tungsten concentration is effectively reduced during the application of RMPs. With mixed harmonics, the toroidal varying steady state heat and particle fluxes on the divertor target can be modified with the rotating n = 2 harmonic, which agrees with the numerical modeling of three-dimensional magnetic topology, with plasma responses being taken into account. ELM suppression correlates with the times of larger n = 3 response with mixed n = 2 and n = 3 RMPs. The mixture of harmonics and the rotating n = 2 harmonic does not require additional coil current because the variation is only in the upper-lower coil current phase space. These results further affirm the effectiveness of integrated ELM and divertor flux control using RMPs with mixed harmonics and improve the understanding of the role of plasma responses in ELM suppression. [ABSTRACT FROM AUTHOR]

EV71-type virus is one of the main pathogens causing the occurrence of hand, foot and mouth disease (HFMD), and VP1 protein, a factor that directly determines the antigenicity of the virus, has been isolated. The tomato was selected as a bioreactor for the production of an edible EV71 vaccine designed for the VP1 capsid protein. Using molecular biology techniques, the fusion gene EV71-VP1 was cut from vector PGEX-4T-2, a vector containing the p2300-EV71 gene with CaMV35S promoter and TL regulatory elements was constructed, and the hypocotyl and cotyledons of tomato were transformed using Agrobacterium (EHA105)-mediated method, screened, elongated and rooted, and finally 20 resistant tomato plants were obtained. Five transgenic positive seedlings were obtained by digestion and PCR assay, among which three plants were detected by RT-PCR to be capable of transcriptional translation at the RNA level. The experimental results aimed to explore new material support for the preparation of transgenic plant oral vaccines against EV71 infection and provide a theoretical basis for accelerating the development of transgenic plant vaccines in the future. [ABSTRACT FROM AUTHOR]

Geometric phase enabled by spin‐orbit coupling has attracted enormous interest in optics over the past few decades. However, it is only applicable to circularly‐polarized light and encounters substantial challenges when applied to wave fields lacking the intrinsic spin degree of freedom. Here, a new paradigm is presented for achieving geometric phase by elucidating the concept of topological complementary pair (TCP), which arises from the combination of two compact phase elements possessing opposite intrinsic topological charge. Twisting the TCP leads to the generation of a linearly‐varying geometric phase of arbitrary order, which is quantified by the intrinsic topological charge. Notably distinct from the conventional spin‐orbit coupling‐based theories, the proposed geometric phase is the direct result of the cyclic evolution of orbital‐angular‐momentum transformation in mode space, thereby exhibiting universality across classical wave systems. As a proof of concept, the existence of this geometric phase is experimentally demonstrated using scalar acoustic waves, showcasing the remarkable ability in the precise manipulation of acoustic waves at subwavelength scales. These findings engender a fresh understanding of wave‐matter interaction in compact structures and establish a promising platform for exploring geometric phase, offering significant opportunities for diverse applications in wave systems. [ABSTRACT FROM AUTHOR]

Many space based gravity missions require frequency stabilized lasers with stringent requirements. Toward those requirements, we develop a compact frequency-stabilized laser which is referenced to the R(56)32−0: a1 transition of molecular iodine based on the modulation transfer spectroscopy technique. The stability of the laser is limited by the beam pointing noise, the electronic servo noise, and the residual amplitude modulation (RAM) noise. To improve the beam pointing stability, the system is constructed by gluing most components of the optical system on an ultra-low expansion glass base. We use a pre-amplifier to suppress the electronic servo noise, and use a wedged electro-optic phase modulator to suppress the RAM noise. The fractional frequency instability of the system is evaluated to be 3.3 × 10−15 at 2 s and 4 s averaging time, and is lower than 6 × 10−15 at averaging times from 1 s to 10 000 s. To our knowledge, this is the best short-term (1–4 s) instability reported so far for an iodine stabilized laser. The stability fully meets the requirements of next generation gravity mission and laser interferometer space antenna mission. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the efficacy of an anti-CD38 nanobody to detect plasma cells in a flow cytometry myeloma minimal residual disease (MRD) panel in patients treated with daratumumab and other immunotherapies. Methods Twenty-three bone marrow samples from as many patients were collected during or at the end of daratumumab treatment cycles. A 5-tube, 8-color flow cytometry MRD panel was performed. Dotplots were reviewed, and the median fluorescence intensity (MFI) was calculated. Results Patients' ages ranged from 45 to 77 years, and the cohort was made up of 13 men and 10 women who had undergone 2 to 24 cycles of daratumumab therapy at the time of myeloma MRD testing. In all 23 cases, therapeutic use of daratumumab impaired pathologists' ability to measure CD38 on plasma cells when using a conventional murine monoclonal antibody (anti-CD38 fluorescein isothiocyanate [FITC], clone T16; Beckman Coulter). In 21 of the 23 cases, the measurement of CD38 was restored when the anti-CD38 nanobody was employed. Compared with anti-CD38 FITC, the anti-CD38 Alexa Fluor 488 nanobody (Beckman Coulter) produced higher MFI and allowed measurement of a higher frequency of discernable plasma cells. Conclusions The camelid-derived CD38 antibody successfully circumvents the steric inhibition of CD38 that the therapeutic use of daratumumab imparts and facilitates myeloma MRD plasma cell detection. [ABSTRACT FROM AUTHOR]

Herein, the precipitation of Al3Zr during one‐ and two‐step homogenization processes is studied by the transmission electron microscopy method, and its effect on recrystallization is investigated by the electron backscattering diffraction technique after the same hot compression and solution treatment, respectively. The results show that when the temperature reaches 430 °C, just some small Al3Zr dispersoids are visible in samples that undergo one‐step treatment. As the first‐step homogenization temperature increases from 365 to 430 °C, Al3Zr radius increases from 9.4 to 19.1 nm while the number density decreases rapidly from 1201 to 183 μm−3. In addition, the average radius of Al3Zr increases to 22.1 nm while the number density decreases to 76 μm−3 when the sample is homogenized at 500 °C/24 h. After a double‐step homogenization with decreased first‐step temperature, lower recrystallization fraction is obtained. Therefore, the optimal homogenization treatment is determined to be 365 °C/16 h + 500 °C/24 h, after which the most desirable Al3Zr distribution and the smallest recrystallization fraction are obtained during thermomechanical process. This result can provide a more appropriate parameter for homogenization treatment in order to achieve a more dispersed distribution, which will result in stronger pinning force during the thermomechanical process. [ABSTRACT FROM AUTHOR]

Transition metal oxide-based supercapacitors have attracted much attention due to their high theoretical specific capacitances. However, due to an insufficient utilization ratio and poor intrinsic conductivity of active materials, the rate performance of these electrodes is usually low. Herein, oxygen defect-mediated NiCo2O4 nanosheets with enhanced electrical conductivity (1.9 S m−1vs. 0.2 S m−1 of original NiCo2O4 NSs) are fabricated using a post NaBH4 reduction strategy (denoted as r-NiCo2O4 NSs). The derived r-NiCo2O4 materials have sheet-like morphology, increased oxygen defects and low valence metal species, and an unprecedented rate capability comparable to that of carbon-based electrode materials, with a satisfactory capacitance of 1812 F g−1 and 91.5% retention at 20 A g−1. The general strategy can be extended to other transition metal oxides to construct enhanced conductivity electrodes for related energy storage and conversion devices. [ABSTRACT FROM AUTHOR]

The ultrasonic melt treatment (UMT) is widely used in the fields of casting and metallurgy. However, there are certain drawbacks associated with the conventional process of single-source ultrasonic (SSU) treatment, such as the fast attenuation of energy and limited range of effectiveness. In this study, the propagation models of SSU and four-source ultrasonic (FSU) in Al melt were respectively established, and the distribution patterns of acoustic and streaming field during the ultrasonic treatment process were investigated by numerical simulation and physical experiments. The simulated results show that the effective cavitation zone is mainly located in a small spherical region surrounding the end of ultrasonic horn during the SSU treatment process. When the FSU is applied, the effective cavitation zone is obviously expanded in the melt. It increases at first and then decreases with increasing the vibration-source spacing (Lv) from 30 mm to 100 mm. Especially, when the Lv is 80 mm, the area of effective cavitation zone reaches the largest, indicating the best effect of cavitation. Moreover, the acoustic streaming level and flow pattern in the melt also change with the increase of Lv. When the Lv is 80 mm, both the average flow rate and maximum flow rate of the melt reach the highest, and the flow structure is more stable and uniform, with the typical morphological characteristics of angular vortex, thus significantly expanding the range of acoustic streaming. The accuracy of the simulation results was verified by physical experiments of glycerol aqueous solution and tracer particles. [ABSTRACT FROM AUTHOR]

Central nervous system (CNS) involvement is a serious complication in hematologic malignancy, and early detection and management of CNS involvement in these cases significantly impact the prognosis. Currently, there is no consensus on the use of multiparametric flow cytometry (MFC) and conventional cytology (CC) testing for initial and follow-up cerebrospinal fluid (CSF) specimens to diagnose CNS involvement by hematologic malignancy. In our institution, after initial MFC and CC, two subsequent negative MFCs are required before discontinuing MFC. The aim of this study is to evaluate the outcome of this approach. CSF cytology and MFC reports were retrieved from Laboratory Information System, and data was reviewed. Between January 2020 and December 2021, 1789 CSF samples from 280 patients were submitted for CSF analysis. For those 517 CSF samples tested by both MFC and CC, 97 cases tested positive by both MFC and CC with 95% concordance. Eighteen cases were MFC + /CC − and 7 were MFC − /CC +. Thirty-six cases had initially positive MFCs followed by more than one MFC evaluation. Among those 36 cases, 22 cases (61.1%) converted to negative after the second follow-up sample, 9 cases (25%) were continuously positive for at least three samples, and 5 cases (13.9%) exhibited negative to positive conversion. Compared to negative CSF cases, positive CSFs had higher total nucleated cell count and higher total protein levels while red blood cells, glucose, and lactate dehydrogenase levels remained at comparable levels. The concordance between MFC and CC was excellent. The high incidence of positive MFCs on two or more follow-up samples and the high frequency of negative MFC to positive conversion indicate the necessity of repeated negative MFCs before discontinuing MFC. The fact that more than half of the positive cases converted to negative after the second CSF specimen and most follow-up positive cases can be detected by CC alone suggests it is adequate to use CC alone for follow-up CSF study after two consecutive negative MFCs. [ABSTRACT FROM AUTHOR]

We design numerically and demonstrate experimentally a planar metamaterial with a narrow band electromagnetically induced transparency (EIT)-like resonance at microwave frequencies. The meta-molecule, consisting of a pair of metallic rectangular rings connected by a top metallic strip, is mirror symmetric with respect to the exciting electric field of the normally incident wave. The coupling between a broad bright mode (electric dipole) of the whole meta-molecule and a sharp dark mode (electric quadrupole) belonging only to the rectangular-ring pair can efficiently induce an ultra-narrow EIT-like resonance. By using a coupled-resonator model that shows good accordance with the numerical and experimental results, the observed effect can be well explained. Our design provides another way to realize the sharp EIT-like behavior with strong dispersion and the slow-wave effect, which may find potential applications in constructing the slow-wave devices, filters, and sensors. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the impact of fall season vitamin D3 supplementation on strength/power, body composition, and anabolic hormones in swimmers with optimal vitamin D status at summer's end. Male and female National Collegiate Athletic Association Division I swimmers (N = 19) with optimal 25-hydroxyvitamin D [25(OH)D] randomly received 5,000 IU of vitamin D3 (VITD) or placebo (PLA) daily for 12 weeks while participating in swimming and strength and conditioning training (August–November). Before and after the intervention, the participants underwent blood sampling for analysis of serum 25(OH)D, parathyroid hormone, total testosterone, free testosterone, sex hormone-binding globulin, and insulin-like growth factor 1, dual-energy X-ray absorptiometry, and strength/power testing (bench press, squat, dead lift, standing broad jump, vertical jump, and dips and pull-ups). Sex was used as a covariate for analyses. The 25(OH)D was decreased by 44% in PLA (p <.05) and increased by 8% in VITD over the 12 weeks. Fat-free mass increased in VITD (56.4–59.1 kg; p <.05), but not PLA (59.4–59.7 kg; p <.01). Significant Group × Time interaction effects were observed for dead lift (F = 21.577, p <.01) and vertical jump (F = 11.219, p <.01), but no other strength/power tests. Total testosterone decreased similarly in both groups, but free testosterone decreased and sex hormone-binding globulin increased only in PLA (p <.01). There were no group differences or changes in insulin-like growth factor 1 with the intervention. The findings suggest that vitamin D supplementation is an efficacious strategy to maintain 25(OH)D during the fall season training and to enhance some aspects of strength/power and fat-free mass in swimmers. Further research on the relationship between vitamin D and anabolic hormones is needed. [ABSTRACT FROM AUTHOR]

In this study, an ultrasound-assisted digestion method of a formic acid-decellularized extracellular matrix (dECM) of porcine skin was developed and optimized to form UdECM hydrogels for diabetic wound healing. Results demonstrated that ultrasonication improved the extraction rate of collagen from dECM samples, preserved the collagen content of dECM, reduced residual cells, and extracted greater DNA contents. Scanning electron microscope (SEM) analyses were performed, which demonstrated the optimal porosity on the surface and density of the cross-section in the hydrogel structure, which could control the release of growth factors embedded in UdECM hydrogels at desirable rates to boost wound healing. A wound-healing study was conducted with six different composite hydrogels, both empty materials and materials enriched with rat platelet-rich plasma (R-PRP), sacchachitin nanofibers (SCNFs), and TEMPO-oxidized sacchachitin in diabetic rats. The assessment based on scars stained with hematoxylin and eosin (H&E), Masson's trichrome (MT), and a cluster of differentiation 31 (CD31) staining showed that the UdECM/SC/R-PRP treatment group had the most significant efficacy of promoting healing and even recovery of diabetic wounds to normal tissues. UdECM/R-PRP and UdECM/SCNFs demonstrated better healing rates than UdECM hydrogel scaffolds, which had only recovered 50% resemblance to normal skin. Treatment with both UdECM/TEMPO 050 and UdECM/TEMPO 050/R-PRP hydrogel scaffolds was ranked last, with even poorer efficacy than UdECM hydrogels. In summary, formulated UdECM and SCNF hydrogels loaded with PRP showed synergistic effects of accelerating wound healing and ultimately stimulating the wound to recover as functional tissues. This newly UdECM/SCNF composite hydrogel has promising potential for healing and regenerating diabetic wounds. [ABSTRACT FROM AUTHOR]

The plasma-beta effect on the n = 1 resonant magnetic perturbation (RMP) field penetration in purely radio-frequency (RF) wave heated discharges has been investigated in EAST. The experimental results show that the dependence of the threshold RMP coil current for field penetration, I RMP,th , on the total absorbed power P tot scales as approximately I RMP,th ∝ P tot 0.30 , indicating that the error-field tolerance is improved with increasing RF power. This is benefited by the increased electron perpendicular flow dominated by a counter-current electron diamagnetic flow with increasing RF power. However, theoretical scaling in cylindrical geometry overestimates the power index. Assuming an additional term β N α β N for the normalized beta in the scaling, it is shown that the fitted α β N from the experimental observation is around −1, indicating a degradation effect of plasma beta. To clarify the underlying physics of the plasma-beta effect that was not included in the theoretical scaling in cylindrical geometry, the MARS-Q code with full toroidal geometry is employed for simulation of nonlinear field penetration (Liu et al 2013 Phys. Plasmas 20 042503). The MARS-Q simulation results reproduce the β N dependence well, and hence the P tot scaling of the threshold current in experimental observations. The main reason for this is that the net total torque, which is mainly contributed by the neoclassical toroidal viscosity (NTV), increases with increasing plasma β N . The results demonstrate that the nonlinear toroidal coupling effect via NTV torque plays an important role in determining field penetration, even in cases with relatively low β N ∈ [ 0.3 , 0.6 ] , which is far less than the no-wall beta limit. [ABSTRACT FROM AUTHOR]

Objectives. To estimate county-level cigarette smoking prevalence in Virginia and examine cigarette use disparities by rurality, Appalachian status, and county-level social vulnerability. Methods. We used 2011–2019 Virginia Behavioral Risk Factor Surveillance System proprietary data with geographical information to estimate county-level cigarette smoking prevalence using small area estimation. We used the Centers for Disease Control and Prevention's social vulnerability index to quantify social vulnerability. We used the 2-sample statistical t test to determine the differences in cigarette smoking prevalence and social vulnerability between counties by rurality and Appalachian status. Results. The absolute difference in smoking prevalence was 6.16 percentage points higher in rural versus urban counties and 7.52 percentage points higher in Appalachian versus non-Appalachian counties in Virginia (P <.001). Adjusting for county characteristics, a higher social vulnerability index is associated with increased cigarette use. Rural Appalachian counties had 7.41% higher cigarette use rates than did urban non-Appalachian areas. Tobacco agriculture and a shortage of health care providers were significantly associated with higher cigarette use prevalence. Conclusions. Rural Appalachia and socially vulnerable counties in Virginia have alarmingly high rates of cigarette use. Implementation of targeted intervention strategies could reduce cigarette use, ultimately reducing tobacco-related health disparities. (Am J Public Health. 2023;113(7):811–814. https://doi.org/10.2105/AJPH.2023.307298) [ABSTRACT FROM AUTHOR]

Although technology-assisted diabetes prevention programs (DPPs) have been shown to improve glycemic control and weight loss, information are limited regarding relevant costs and their cost-effectiveness. To describe a retrospective within-trial cost and cost-effectiveness analysis (CEA) to compare a digital-based DPP (d-DPP) with small group education (SGE), over a 1-year study period. The costs were summarized into direct medical costs, direct nonmedical costs (i.e. times that participants spent engaging with the interventions), and indirect costs (i.e. lost work productivity costs). The CEA was measured by the incremental cost-effectiveness ratio (ICER). Sensitivity analysis was performed using nonparametric bootstrap analysis. Over 1 year, the direct medical costs, direct nonmedical costs, and indirect costs per participant were $4,556, $1,595, and $6,942 in the d-DPP group versus $4,177, $1,350, and $9,204 in the SGE group. The CEA results showed cost savings from d-DPP relative to SGE based on a societal perspective. Using a private payer perspective for d-DPP, ICERs were $4,739 and $114 to obtain an additional unit reduction in HbA1c (%) and weight (kg), and were $19,955 for an additional unit gain of quality-adjusted life years (QALYs) compared to SGE, respectively. From a societal perspective, bootstrapping results indicated that d-DPP has a 39% and a 69% probability, at a willingness-to-pay of $50,000/QALY and $100,000/QALY, respectively, of being cost-effective. The d-DPP was cost-effective and offers the prospect of high scalability and sustainability due to its program features and delivery modes, which can be easily translated to other settings. [ABSTRACT FROM AUTHOR]

Background: Fruit and vegetable (FV) consumption in children in the United States (US) is very low. Adequate FV consumption is required for proper development during childhood, and dietary habits are established during preschool-age and tend to persist into adulthood. As most U.S. preschool-aged children attend childcare or preschool, this may be an opportune time and setting to conduct interventions to improve FV intake. These interventions should be based in theory and use behavior change techniques (BCTs) to explain mechanisms for expected change. To date, no published reviews have examined the effectiveness of childcare- or preschool-based FV interventions in preschoolers and their use of theoretical frameworks and BCTs. Methods: This systematic review was completed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were randomized controlled trials (RCTs) published between 2012 and 2022 of interventions to improve diet or FV intake in preschoolers (aged 2–5 years) in childcare or preschool-settings. A search of four databases was conducted between in September 2022 using search terms pertaining to the study's primary aim (FV consumption), age group (preschool-aged), settings (US childcare or preschool settings), and study design (RCT). Additional criteria were objective measures of FV consumption or skin carotenoids, as a proxy for FV intake. Included studies were narratively synthesized based on intervention type, measured effect, and use of theory and BCTs. Results: The search resulted in six studies that reported on nine interventions. Overall, six interventions increased FV intake, of which five used nutrition education and one manipulated the feeding environment. Among the three interventions with no measured effect, two manipulated the feeding environment and one used peer modeling. Effective studies used at least three BCTs, though no pattern was observed between use of theory or BCTs and intervention effect. Conclusions: While several studies have shown promising results, the limited number of studies identified in this review highlights key gaps in this field: there is a need for studies to test FV interventions in US childcare settings that use objective measures of FV intake, directly compare intervention components and BCTs, are theory-based, and assess long-term behavior change. [ABSTRACT FROM AUTHOR]

Background: Fruit and vegetable (FV) consumption in children in the United States (US) is very low. Adequate FV consumption is required for proper development during childhood, and dietary habits are established during preschool-age and tend to persist into adulthood. As most U.S. preschool-aged children attend childcare or preschool, this may be an opportune time and setting to conduct interventions to improve FV intake. These interventions should be based in theory and use behavior change techniques (BCTs) to explain mechanisms for expected change. To date, no published reviews have examined the effectiveness of childcare- or preschool-based FV interventions in preschoolers and their use of theoretical frameworks and BCTs. Methods: This systematic review was completed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were randomized controlled trials (RCTs) published between 2012 and 2022 of interventions to improve diet or FV intake in preschoolers (aged 2–5 years) in childcare or preschool-settings. A search of four databases was conducted between in September 2022 using search terms pertaining to the study's primary aim (FV consumption), age group (preschool-aged), settings (US childcare or preschool settings), and study design (RCT). Additional criteria were objective measures of FV consumption or skin carotenoids, as a proxy for FV intake. Included studies were narratively synthesized based on intervention type, measured effect, and use of theory and BCTs. Results: The search resulted in six studies that reported on nine interventions. Overall, six interventions increased FV intake, of which five used nutrition education and one manipulated the feeding environment. Among the three interventions with no measured effect, two manipulated the feeding environment and one used peer modeling. Effective studies used at least three BCTs, though no pattern was observed between use of theory or BCTs and intervention effect. Conclusions: While several studies have shown promising results, the limited number of studies identified in this review highlights key gaps in this field: there is a need for studies to test FV interventions in US childcare settings that use objective measures of FV intake, directly compare intervention components and BCTs, are theory-based, and assess long-term behavior change. [ABSTRACT FROM AUTHOR]

Measurable residual disease (MRD) detection for precursor B-lymphoblastic leukemia (B-ALL) has become the standard of care. However, the testing methodology has not been standardized. We aim to correlate COG multiparameter flow cytometry (MFC) and ClonoSEQ techniques to assess the test characteristics, to study abnormal immunophenotype for B-ALL MRD, and to observe B-ALL clonal evolution and the impact of blinatumomab therapy on MFC testing. MFC and molecular reports were retrieved from electronic medical records and data was reviewed. Included in this study were 74 bone marrow samples collected from 31 B-ALL patients at our institution between January 2021 and March 2022. COG MFC and ClonoSEQ results were concordant in 59/74 samples (80%) with positive concordant results in 12 samples (16%) and negative concordant results in 47 samples (64%). Discordant results were seen in 15/74 samples (20%), with 14 samples (19%) showing ClonoSEQ + /MFC- results and only 1 sample (1%) showing MFC + /ClonoSEQ- result. ClonoSEQ + /MFC- cases had MRD values ranging from 1 to 1400 cells/million nucleated cells with 86% of cases showing MRD values of < 100 cells/million nucleated cells. Newly identified dominant sequences were detected using ClonoSEQ in 2/31 patients (6%) during follow-up. All 14 bone marrow samples from 8 patients, who had gone through blinatumomab immunotherapy, were MRD negative by MFC, but 3 cases were MRD positive by ClonoSEQ. Our results show strong correlation between COG MFC and ClonoSEQ (r = 0.96), and both methods are complementary. Clonal evolution may occur, and blinatumomab immunotherapy may impact MFC B-ALL MRD evaluation. [ABSTRACT FROM AUTHOR]

In order to determine a way to be able to shorten the smelting time of low-carbon ferrochrome alloys and to strengthen the temperature control capability of the AOD converter during the smelting process, this article establishes a mechanism model of the rate of oxygen supply and carbon content change in the smelting process as well as the temperature of the reaction fluid in the converter. The physical and chemical reactions of the smelting process and the actual smelting data are used as the basis. The temperature and carbon content in the smelting converter are considered as the output quantity and the rate of oxygen supply is considered as the input quantity. An expert internal model control framework is built. In addition, an adaptive parameter adjustment mechanism is added to the control framework, taking into account data such as the maximum gas supply rate and the maximum limiting temperature of the actual production process. This method improves the smelting speed and smelting accuracy compared to the general internal mode control method. Finally, according to this method, with the use of the built low-carbon ferrochrome alloy centralized control system for smelting, the system shortens the smelting time by 12.79% compared with the general method and controls the converter temperature below 1950 K, which achieves the expected goal according to the simulation and actual smelting results. [ABSTRACT FROM AUTHOR]

In this paper, we discuss quantum randomness expansion using the unreliable source device and the honest measure device consisting of mutually unbiased bases in 3-dimensional Hilbert space. Then, we obtain the relationship between 3-dimensional quantum witness and random number generation rate. Furthermore, the analytic expression of the relationship is given, which is of great significance for security analysis and practical application. This work can be considered a preliminary attempt for semi-device-independent quantum random number extension protocols in 3-dimensional Hilbert space. [ABSTRACT FROM AUTHOR]

To enhance the rate of argon–oxygen refining of ferroalloys, this article is based on the physical and chemical reactions of the smelting process as well as the actual smelting data. A mechanistic model of the rate of change of oxygen supply and carbon content in the smelting process and the temperature of the reaction fluid in the furnace is established. An expert internal model control framework with furnace temperature and carbon content as output and oxygen supply rate as input is constructed. An adaptive parameter adjustment mechanism is added to the control framework by combining data on the maximum gas supply rate and temperature threshold of the stage in the actual production process. The method improves smelting speed and smelting accuracy compared to the general method. It is also able to adjust the furnace temperature according to the actual smelting situation. The actual smelting was carried out according to this method, the improved method reduced the smelting time by 12.79% compared to the general method, and the furnace temperature was controlled below 1950 K. [ABSTRACT FROM AUTHOR]