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Background: Long specialist outpatient waiting lists are a source of clinical risk. Triage assignment is based on subjective assessment of referrals and fails to account for dynamic changes in disease status while patients await clinical review., Aims: To pilot an innovative triage method using a trifold approach to conduct noninvasive assessment of fibrosis and to determine the feasibility of reflex hepatitis C virus (HCV) polymerase chain reaction (PCR) testing., Methods: A total of 1006 patients awaiting an initial liver clinic appointment at a tertiary Australian hospital were sent a short message service (SMS) requesting a blood test be completed. The first 60 patients received an SMS only, and the subsequent 946 patients also received a phone call from a Liver Care Guide (LCG), a nonclinician employed to increase patient engagement. Liver fibrosis assessment through noninvasive testing was performed using an aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB4) score. Patients with an APRI ≥1, FIB4 ≥3.25 or positive HCV PCR were retriaged to Category 1., Results: Four hundred ninety (49%) patients completed testing and 40 (4%) were triaged to Category 1. Subanalyses demonstrated increased response rates with LCG input (P = 0.012). Retriaged patients had been on the waitlist for a median of 216 days, exceeding initial category recommendations., Conclusion: This study successfully implemented a semiautomated strategy that prioritises patients with probable advanced liver disease or active HCV, demonstrating enhanced patient engagement with LCG support. It highlights the burden of patients referred for specialist care and the need for innovative strategies for monitoring and objective risk stratification., (© 2024 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)

Competing Interests: Conflicts of interest None disclosed.

What Is Known on the Subject: Peer research methodologies and methods are increasingly used in research, particularly to benefit from lived experiences. The experiences of peer researchers with severe mental illness are less common, including the impact on them of conducting peer-led research., What the Paper Adds to Existing Knowledge: This paper shares the experience of peer research and suggests in the context of food insecurity, that it is not well understood by some healthcare professionals., What Are the Implications for Practice: Implications include considerations around trauma-informed care and the need for screening for food insecurity in mental healthcare settings. Research implications include providing training for peer research and needing to consider longevity of peer researcher relationships., Abstract: Introduction Food insecurity means that a person does not have access to sufficient nutritious food for normal growth and health. This can lead to health problems such as obesity, heart disease, diabetes and other long term chronic health conditions. People living with a severe mental illness are more likely to experience food insecurity than people without a severe mental illness. Aim The aim of this paper is to present a lived experience narrative of two peer researchers. Peer researchers conducted interviews with adults with severe mental illness from Northern England as part of a funded research project. These interviews discussed experiences of food insecurity and strategies to tackle it and were conducted between March and December 2022. Thesis The following paper does not discuss the results of the interviews themselves. Rather the narrative begins with an overview of peer research, before sharing the experiences of the two peer researchers in undertaking this project. Implications for Practice This includes healthcare professionals understanding food insecurity, what it is and what it is not, thinking about trauma-informed care, and screening for food insecurity. Peer research implications centre on adequate support and training, considerations to longevity of peer research relationships and reducing unnecessary research burden for peer researchers., (© 2024 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Objective: Continuous glucose monitoring (CGM) can detect early dysglycemia in older children and adults with presymptomatic type 1 diabetes (T1D) and predict risk of progression to clinical onset. However, CGM data for very young children at greatest risk of disease progression are lacking. This study aimed to investigate the use of CGM data measured in children being longitudinally observed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study from birth to age 10 years., Research Design and Methods: Between January 2021 and June 2023, 31 ENDIA children with persistent multiple islet autoimmunity (PM Ab+) and 24 age-matched control children underwent CGM assessment alongside standard clinical monitoring. The CGM metrics of glucose SD (SDSGL), coefficient of variation (CEV), mean sensor glucose (SGL), and percentage of time >7.8 mmol/L (>140 mg/dL) were determined and examined for between-group differences., Results: The mean (SD) ages of PM Ab+ and Ab- children were 4.4 (1.8) and 4.7 (1.9) years, respectively. Eighty-six percent of eligible PM Ab+ children consented to CGM wear, achieving a median (quartile 1 [Q1], Q3) sensor wear period of 12.5 (9.0, 15.0) days. PM Ab+ children had higher median (Q1, Q3) SDSGL (1.1 [0.9, 1.3] vs. 0.9 [0.8, 1.0] mmol/L; P < 0.001) and CEV (17.3% [16.0, 20.9] vs. 14.7% [12.9, 16.6]; P < 0.001). Percentage of time >7.8 mmol/L was greater in PM Ab+ children (median [Q1, Q3] 8.0% [4.4, 13.0] compared with 3.3% [1.4, 5.3] in Ab- children; P = 0.005). Mean SGL did not differ significantly between groups (P = 0.10)., Conclusions: CGM is feasible and well tolerated in very young children at risk of T1D. Very young PM Ab+ children have increased SDSGL, CEV, and percentage of time >7.8 mmol/L, consistent with prior studies involving older participants., (© 2024 by the American Diabetes Association.)

Health and allied health professionals are uniquely positioned to collaborate in prevention, early intervention and responses to child maltreatment. Effective collaboration requires comprehensive interprofessional education (IPE), and inadequate collaboration across sectors and professions continually contributes to poor outcomes for children. Little is known about what interprofessional preparation health and allied health professionals receive before initial qualification (preservice) that equips them for interprofessional collaboration and provision of culturally safe care in child protection. This scoping review aimed to identify what is known internationally about IPE in child protection for preservice health and allied health professionals. Thirteen manuscripts reporting 12 studies met the inclusion criteria and were included in the synthesis. Key characteristics of the educational interventions are presented, including target disciplines, core content and their learning objectives and activities. Findings demonstrated primarily low-quality methodologies and educational interventions that had not been replicated beyond their initial context. Many educational interventions did not provide comprehensive content covering the spectrum of prevention, early intervention and responses for all types of child maltreatment, and/or did not clearly indicate how IPE was achieved. Key challenges to delivering comprehensive interprofessional child protection include lack of institutional support and competing priorities across disciplines who must meet requirements of separate regulatory bodies. Consequently, there is a need for further development and robust evaluation of educational interventions to explore how interprofessional collaborative skills for child protection can be developed and delivered in preservice health and allied health professional education., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The 2015 American College of Medical Genetics/Association of Molecular Pathology (ACMG/AMP) variant classification framework specifies that case-control observations can be scored as 'strong' evidence (PS4) towards pathogenicity., Methods: We developed the PS4-likelihood ratio calculator (PS4-LRCalc) for quantitative evidence assignment based on the observed variant frequencies in cases and controls. Binomial likelihoods are computed for two models, each defined by prespecified OR thresholds. Model 1 represents the hypothesis of association between variant and phenotype (eg, OR≥5) and model 2 represents the hypothesis of non-association (eg, OR≤1)., Results: PS4-LRCalc enables continuous quantitation of evidence for variant classification expressed as a likelihood ratio (LR), which can be log-converted into log LR (evidence points). Using PS4-LRCalc, observed data can be used to quantify evidence towards either pathogenicity or benignity. Variants can also be evaluated against models of different penetrance. The approach is applicable to balanced data sets generated for more common phenotypes and smaller data sets more typical in very rare disease variant evaluation., Conclusion: PS4-LRCalc enables flexible evidence quantitation on a continuous scale for observed case-control data. The converted LR is amenable to incorporation into the now widely used 2018 updated Bayesian ACMG/AMP framework., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Casasanto (Journal of Experimental Psychology: General, 138, 351-367, 2009) conceptualised the body-specificity hypothesis by empirically finding that right-handed people tend to associate a positive valence with the right side and a negative valence with the left side, whilst left-handed people tend to associate a positive valence with the left side and negative valence with the right side. Thus, this was the first paper that showed a body-specific space-valence mapping. These highly influential findings led to a substantial body of research and follow-up studies, which could confirm the original findings on a conceptual level. However, direct replications of the original study are scarce. Against this backdrop and given the replication crisis in psychology, we conducted a direct replication of Casasanto's original study with 2,222 participants from 12 countries to examine the aforementioned effects in general and also in a cross-cultural comparison. Our results support Casasanto's findings that right-handed people associate the right side with positivity and the left side with negativity and vice versa for left-handers., (© 2024. The Author(s).)

Due to the widespread use of insecticides in agriculture and for urban pest control, there is the potential for contamination of groundwater systems. Five neonicotinoids, fipronil, and nine transformation products (desnitro-imidacloprid, imidacloprid olefin, imidacloprid urea, acetamiprid-n-desmethyl, thiacloprid amide, 6-chloronicotinic acid, fipronil desulfinyl, fipronil sulfide, and fipronil sulfone) were studied in samples from 15 springs and 75 unique wells from 13 counties over four years (2019-2022) in Minnesota. Up to 13 neonicotinoids and fiproles were identified in groundwater samples from springs and 10 from wells. Springs were particularly susceptible to contamination, with clothianidin found in 41 % of springs (maximum concentration: 200 ng/L) followed by thiamethoxam (31 %), imidacloprid (22 %), thiacloprid (19 %), and acetamiprid (12 %). Clothianidin was the most common analyte in well samples (13 %), followed by thiamethoxam (12 %), acetamiprid (14 %), imidacloprid (10 %), and thiacloprid (2 %). Hydrostratigraphy was an important factor in neonicotinoid detection with frequencies of detection highest in sandy or karst aquifers. Regional land use, especially the fraction of agricultural land, and imperviousness influenced observed concentrations within springsheds and well catchment areas. There were several significant correlations between neonicotinoid detections with geochemistry indicators including tritium/groundwater age, dissolved oxygen (DO), and total nitrate plus nitrite (total oxidized nitrogen)., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: William Arnold reports financial support was provided by Environment and Natural Resources Trust Fund. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The NLRP3 inflammasome is a multi-protein molecular machine that mediates inflammatory responses in innate immunity. Its dysregulation has been linked to a large number of human diseases. Using cryogenic fluorescence-guided focused-ion-beam (cryo-FIB) milling and electron cryo-tomography (cryo-ET), we obtained 3-D images of the NLRP3 inflammasome in situ at various stages of its activation at macromolecular resolution. The cryo-tomograms unexpectedly reveal dense condensates of the human macrophage NLRP3 inflammasome that form within and around the microtubule organizing center (MTOC). We also find that following activation, the trans-Golgi network disperses and 50-nm NLRP3-associated vesicles appear which likely ferry NLRP3 to the MTOC. At later time points after activation, the electron-dense condensates progressively solidify and the cells undergo pyroptosis with widespread damaged mitochondria and autophagasomal structures.

Objective: To determine the efficacy of advanced hybrid closed loop (AHCL) therapy in a high-risk cohort of youth on continuous subcutaneous insulin infusion (CSII) ± continuous glucose monitoring (CGM) with suboptimal glycemia., Research Design and Methods: In a 6-month multicenter clinical trial, youth with type 1 diabetes with mean and most recent HbA1c > 8.5% (65 mmol/mol) were randomly assigned 1:1 to AHCL or treatment as usual (CSII ± CGM). The primary outcome was the 24-week between-group difference in HbA1c. Secondary outcomes included CGM metrics from masked CGM and psychological measures (youth-reported problem areas in diabetes [PAID], quality of life, anxiety, depression, and hypoglycemia fear) assessed using validated questionnaires., Results: A total of 42 participants were randomized (mean [SD] age 16.2 [2.5] years, HbA1c 9.8 [1.1]% or 84 [12] mmol/mol, PAID score 50.3 [19.8]). At study end, the mean (SD) HbA1c was 8.8 (1.1)% or 73 (12) mmol/mol with AHCL and 9.9 (1.2)% or 85 (13.1) mmol/mol with CSII ± CGM, with mean adjusted group difference of -0.77% (95% CI -1.45 to -0.09) or -8.4 mmol/mol (-15.8 to -1.0); P = 0.027. AHCL increased time in range 70-180 mg/dL (difference 19.1%; 95% CI 11.1 to 27.1), reduced time >180 mg/dL (difference -17.7%; 95% CI -26.6 to -8.8), with no increase in time spent <70 mg/dL (difference -0.8%; 95% CI -2.7 to 0.6). There was no evidence for difference in psychosocial outcomes between the two groups at study end., Conclusions: AHCL should be encouraged in youth with suboptimal glycemia, as AHCL improves glycemia. However, psychological support remains vital, as technology alone may not be able to reduce the burden of diabetes care in this subgroup., (© 2024 by the American Diabetes Association.)

Purpose: Early-stage endometrial cancer is often treated with hysterectomy followed by adjuvant vaginal cuff brachytherapy (VCB). Financial toxicity from cancer treatment can impact treatment completion. The Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared to Standard of Care trial is a multicenter, prospective randomized trial of standard of care (SoC) VCB doses delivered in 3 to 5 fractions per the physician's discretion compared with a 2-fraction course. We report on secondary cost endpoints, quantifying the financial impacts of shorter treatment courses on institutions and participating patients., Methods and Materials: Technical (TechCs), professional, and total charges (TotCs) were collected prospectively and are reported as raw and Medicare-adjusted charges per patient. Distance to the treatment center and the median income for each patient's zip code were estimated. The Mann-Whitney U statistic, t test, and X 2 test were used to compare characteristics between the 2 groups., Results: One hundred eight patients were analyzed. SoC VCB was delivered in 3, 4, and 5 fractions for 27 of 54 patients (50%), 11 of 54 (20%), and 16 of 54 (30%), respectively. The median total distance traveled per patient for SoC versus experimental arms was 213 versus 137 miles (p = .12), and the median cost of commute for patients was $36.3 versus $18.0 (p = .11). Compared with 2-fraction treatment, 5-fraction treatment resulted in longer travel distances (median, 462 vs 137 miles; p < .01) and increased travel costs (median, $59.3 vs $18.0; p ≤ .01). Unadjusted raw professional charges in USD per patient did not differ between SoC versus experimental arms ($9159 vs $7532; p = .19). TechCs were significantly higher in the SoC arm ($35,734 vs $24,696; p ≤ .01), as were TotCs ($44,892 vs $32,228; p < .01;). Medicare-adjusted TechCs and TotCs were higher for the SoC arm., Conclusions: Two-fraction VCB resulted in fewer treatments per patient, reduced cost of travel compared with longer courses, and an adjusted reduction in health care expenditures compared with SoC., (Copyright © 2024 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

Background: Prevention programs, and specifically exercise, can reduce falls among community-dwelling older adults, but low adherence limits the benefits of effective interventions. Technology may overcome some barriers to improve uptake and engagement in prevention programs, although less is known on adherence for providing them via this delivery mode. We aimed to synthesize evidence for adherence to technology-based falls prevention programs in community-dwelling older adults 60 years and older. We conducted a systematic review following standard guidelines to identify randomized controlled trials for remote delivered (i.e., no or limited in-person sessions) technology-based falls prevention programs for community-dwelling older adults. We searched nine sources using Medical Subject Headings (MeSH) terms and keywords (2007-present). The initial search was conducted in June 2023 and updated in December 2023. We also conducted a forward and backward citation search of included studies. Two reviewers independently conducted screening and study assessment; one author extracted data and a second author confirmed findings. We conducted a random effects meta-analysis for adherence, operationalized as participants' completion of program components, and aimed to conduct meta-regressions to examine factors related to program adherence and the association between adherence and functional mobility. We included 11 studies with 569 intervention participants (average mean age 74.5 years). Studies used a variety of technology, such as apps, exergames, or virtual synchronous classes. Risk of bias was low for eight studies. Five interventions automatically collected data for monitoring and completion of exercise sessions, two studies collected participants' online attendance, and four studies used self-reported diaries or attendance sheets. Studies included some behavior change techniques or strategies alongside the technology. There was substantial variability in the way adherence data were reported. The mean (range) percent of participants who did not complete planned sessions (i.e., dropped out or lost to follow-up) was 14% (0-32%). The pooled estimate of the proportion of participants who were adherent to a technology-based falls prevention program was 0.82 (95% CI 0.68, 0.93) for studies that reported the mean number of completed exercise sessions. Many studies needed to provide access to the internet, training, and/or resources (e.g., tablets) to support participants to take part in the intervention. We were unable to conduct the meta-regression for adherence and functional mobility due to an insufficient number of studies. There were no serious adverse events for studies reporting this information (n = 8). The use of technology may confer some benefits for program delivery and data collection. But better reporting of adherence data is needed, as well as routine integration and measurement of training and skill development to use technology, and behavior change strategies within interventions. There may be an opportunity to rethink or reimagine how technology can be used to support people's adoption and integration of physical activity into daily life routines., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ashe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Using cyclic voltammetry under illumination, we recently demonstrated that CdS quantum dots (QDs) form charge donor states that live for at least several minutes after illumination ends, ∼12 orders of magnitude longer than expected for free carriers. This time scale suggests that the conventionally accepted mechanism of charge transfer, wherein charges directly transfer to an acceptor following exciton dissociation, cannot be complete. Because of these long time scales, this unconventional pathway is not readily observed using time-resolved spectroscopy to probe charge transfer dynamics. Here, we investigated the chemical nature of these charge donor states using cyclic voltammetry under illumination coupled with NMR spectroscopy, X-ray diffraction, X-ray photoelectron spectroscopy, and optical spectroscopy. Our data reveal that charges are stored locally rather than as free carriers, and the number of charges stored is dependent on the QD surface ligation and stoichiometry. Altogether, our results confirm that electrons are stored at ligated surface Cd, these sites are competent charge donors, and this storage is charge balanced by X-type ligand desorption. We found that charge storage occurs in every QD system studied, including CdS, CdSe, and InP capped with carboxylate and phosphonate ligands.

Physical environment plays a key role in determining human health risks. Exposure to toxins, weather extremes, degraded air and water quality, high levels of noise and limited accessibility to green areas can negatively affect health. Furthermore, adverse environmental exposures are often correlated with each other and with socioeconomic status, thereby compounding disadvantages in marginalized populations. Moreover, despite their importance in determining human health risks, the role of multiple environmental exposures is not well studied, and only a few resources contain aggregate environmental exposure data and only for selected areas of the contiguous US. To fill these gaps, we took a cumulative approach to measuring the environment by generating a composite Multi-Exposure Environmental Index (MEEI) as a US Census Tract-level summary of key environmental factors with known health effects. This measure quantifies multiple environmental exposures in the same area that can result in additive and synergistic effects on health outcomes. This information is crucial to better understand and possibly leverage environmental determinants of health for informed policy-making and intervention., (Published by Elsevier Ltd.)

Ecologists are being challenged to predict how ecosystems will respond to climate changes. According to the Multi-Colored World (MCW) hypothesis, climate impacts may not manifest because consumers such as fire and herbivory can override the influence of climate on ecosystem state. One MCW interpretation is that climate determinism fails because alternative ecosystem states (AES) are possible at some locations in climate space. We evaluated theoretical and empirical evidence for the proposition that forest and savanna are AES in Africa. We found that maps which infer where AES zones are located were contradictory. Moreover, data from longitudinal and experimental studies provide inconclusive evidence for AES. That is, although the forest-savanna AES proposition is theoretically sound, the existing evidence is not yet convincing. We conclude by making the case that the AES proposition has such fundamental consequences for designing management actions to mitigate and adapt to climate change in the savanna-forest domain that it needs a more robust evidence base before it is used to prescribe management actions., (© 2024 The Author(s). New Phytologist © 2024 New Phytologist Foundation.)

Whole-exome sequencing of two unrelated kindreds with systemic autoimmune disease featuring antinuclear antibodies with IgG4 elevation uncovered an identical ultrarare heterozygous TNIP1 Q333P variant segregating with disease. Mice with the orthologous Q346P variant developed antinuclear autoantibodies, salivary gland inflammation, elevated IgG2c, spontaneous germinal centers and expansion of age-associated B cells, plasma cells and follicular and extrafollicular helper T cells. B cell phenotypes were cell-autonomous and rescued by ablation of Toll-like receptor 7 (TLR7) or MyD88. The variant increased interferon-β without altering nuclear factor kappa-light-chain-enhancer of activated B cells signaling, and impaired MyD88 and IRAK1 recruitment to autophagosomes. Additionally, the Q333P variant impaired TNIP1 localization to damaged mitochondria and mitophagosome formation. Damaged mitochondria were abundant in the salivary epithelial cells of Tnip1 Q346P mice. These findings suggest that TNIP1-mediated autoimmunity may be a consequence of increased TLR7 signaling due to impaired recruitment of downstream signaling molecules and damaged mitochondria to autophagosomes and may thus respond to TLR7-targeted therapeutics., (© 2024. The Author(s).)

Background: The 6th International Consensus Statement on Concussion in Sport guidelines identified that measuring autonomic nervous system dysfunction using orthostatic vital signs (VSs) is an important part of the clinical evaluation; however, there are limited data on the frequency of autonomic nervous system dysfunction captured via orthostatic VSs after concussion., Purpose: To compare orthostatic changes in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) between athletes with acute sport-related concussion (SRC) and control athletes., Study Design: Cross-sectional study; Level of evidence, 3., Methods: We compared 133 athletes (mean age, 15.3 years; age range, 8-28 years; 45.9% female) with acute SRC (<30 days after injury) with 100 control athletes (mean age, 15.7 years; age range, 10-28 years; 54.0% female). Given the broad age range eligible for study inclusion, participants were subdivided into child (younger than 13 years of age), adolescent (13-17 years of age), and adult (18 years of age and older) age groups for subanalyses. Participants completed a single standard orthostatic VS evaluation including HR, SBP, and DBP in the supine position then immediately and 2 minutes after standing. Linear regression was used to compare delayed supine-to-standing changes in HR, SBP, and DBP as a continuous variable (ΔHR, ΔSPB, and ΔDBP) between groups, and logistic regression was used to compare patients with positive orthostatic VS changes (sustained HR increase ≥30 beats per minute [bpm], SBP decrease ≥20 mm Hg, and DBP ≥10 mm Hg at 2 minutes) between groups, accounting for age and sex., Results: Between-group differences were present for delayed ΔHR (18.4 ± 12.7 bpm in patients with SRC vs 13.2 ± 11.0 bpm in controls; P = .002) and ΔSPB (-3.1 ± 6.6 bpm in patients with SRC vs -0.4 ± 6.5 bpm in controls; P = .001), with positive orthostatic HR changes present more frequently in patients with SRC (18% vs 7%; odds ratio, 2.79; P = .027). In the SRC group, a weak inverse relationship was present between age and ΔHR ( r = -0.171; P = .049), with positive orthostatic HR findings occurring primarily in the child and adolescent SRC subgroups., Conclusion: Patients with acute SRC had greater orthostatic VS changes compared with controls, the most prominent being sustained HR elevations. Clinical evaluation of autonomic change after SRC via standard orthostatic VS assessment may be a helpful clinical biomarker in the assessment of SRC, especially in children and adolescents., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.T.L. has received consulting fees from Alexion Pharmaceuticals and Novartis Pharmaceuticals. J.G. has received payment for a speaking engagement from Arthrex Technology, Pinnacle Inc, and Joint Restoration Foundation; and consulting fees from Vericel Corporation and Joint Restoration Foundation. M.J.P. has received payment for a speaking engagement from Intuitive Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Introduction: The treatment of complex radial head fractures remains controversial with open reduction and internal fixation (ORIF), radial head arthroplasty, and radial head excision being the most common treatment options. While ORIF is the preferred treatment strategy for Mason type II fractures, the optimal treatment of Mason type III fractures is debated., Purpose: To report minimum 10-year outcomes after ORIF of Mason type II and type III radial head fractures. We hypothesized that both Mason Type II and Type III fracture patients would demonstrate satisfactory clinical outcomes at minimum 10-year follow-up., Methods: All patients with Mason type II or III radial head fractures who were treated with ORIF by a single surgeon between 2005 and 2010 were included. Fractures with significant bone defects were treated with bone grafts and elbow ligament injuries were treated with either primary ligament repair or reconstruction. Patient reported outcome (PRO) questionnaires were administered at the time of last clinical follow-up and at a minimum of 10 years postoperatively., Results: Twenty-four patients, including 13 male and 11 female patients with an average age of 39 (range 19-60) at the time of surgery met inclusion criteria. Thirteen patients suffered from Mason type II and 11 patients from Mason type III fractures. At initial follow-up, 21 out of 24 fractures (88%) demonstrated radiographic union. Three non-unions, 2 of which were Mason type III fractures, were treated with revision ORIF and iliac crest bone grafting. 11 patients developed postoperative elbow stiffness and required capsular release surgery. At last clinical follow-up, average flexion was 139 degrees, average extension was 4 degrees, average supination was 77 degrees, and average pronation was 81 degrees. The median DASH score was 7 (ranging from 0 - 32). Minimum 10-year follow-up (mean: 14.6 years) was collected on 18 of 24 (75%) of the patients. At a minimum of 10 years postoperatively, the median QuickDASH score was 4.5 (range: 0 to 25) and the median SANE score was 96.5 (range: 75-100). Median satisfaction with the surgical outcome was 10/10 (range: 3-10)., Conclusion: ORIF of Mason type II and III radial head fractures results in high union rates with good functional outcomes at a mean of 14.6 years postoperatively. The study results suggest that ORIF of Mason type II and III radial head fractures leads to long-term positive functional outcomes., (Copyright © 2024. Published by Elsevier Inc.)

The chemokine CCL28 is highly expressed in mucosal tissues, but its role during infection is not well understood. Here, we show that CCL28 promotes neutrophil accumulation in the gut of mice infected with Salmonella and in the lung of mice infected with Acinetobacter . Neutrophils isolated from the infected mucosa expressed the CCL28 receptors CCR3 and, to a lesser extent, CCR10, on their surface. The functional consequences of CCL28 deficiency varied between the two infections: Ccl28 -/- mice were highly susceptible to Salmonella gut infection but highly resistant to otherwise lethal Acinetobacter lung infection. In vitro, unstimulated neutrophils harbored pre-formed intracellular CCR3 that was rapidly mobilized to the cell surface following phagocytosis or inflammatory stimuli. Moreover, CCL28 stimulation enhanced neutrophil antimicrobial activity, production of reactive oxygen species, and formation of extracellular traps, all processes largely dependent on CCR3. Consistent with the different outcomes in the two infection models, neutrophil stimulation with CCL28 boosted the killing of Salmonella but not Acinetobacter . CCL28 thus plays a critical role in the immune response to mucosal pathogens by increasing neutrophil accumulation and activation, which can enhance pathogen clearance but also exacerbate disease depending on the mucosal site and the infectious agent., Competing Interests: GW, AP, SS, ML, EB, ND, SB, RG, KM, GN, FA, FD, LP, VS, RC, SR, MC, JM, SN, VN, MR No competing interests declared, (© 2024, Walker, Perez-Lopez et al.)

Background: Labral repair has become the preferred method for the arthroscopic treatment of acetabular labral tears that are associated with femoroacetabular impingement (FAI) resulting in pain and dysfunction. Labral reconstruction is performed mainly in revision hip arthroscopy but can be utilized in the primary setting for absent or calcified labra. The purpose of this study was to compare the minimum 2-year patient-reported outcomes (PROs) and risk of revision or conversion to arthroplasty between primary labral reconstruction and primary labral repair., Methods: Patients with FAI who underwent primary hip arthroscopy with labral repair or reconstruction performed by the senior author between 2006 and 2018 were identified from a prospectively enrolled patient outcome registry. Exclusion criteria included confounding injuries, dysplasia, prior ipsilateral hip surgery, or a joint space of <2 mm. Patients who were 18 to 80 years old were eligible for inclusion. Multiple regression with inverse propensity score weighting was conducted to estimate the average treatment effect in the treated (ATT) for labral reconstruction versus labral repair with respect to postoperative PROs and the likelihood of subsequent surgery (revision hip arthroscopy or conversion to arthroplasty). PRO end points included the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL), modified Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index total score (WOMAC), 12-Item Short Form Health Survey Physical Component Summary score (SF-12 PCS), and patient satisfaction., Results: A total of 150 hips undergoing primary labral reconstruction and 998 hips undergoing primary labral repair were included. The median follow-up time was 5.3 years in the reconstruction group and 5.8 years in the repair group. Compared with labral repair, labral reconstruction was associated with a higher risk of conversion to total hip arthroplasty (THA) (20% versus 7%; adjusted odds ratio, 3.2; 95% confidence interval [CI], 1.2 to 8.8; p = 0.024). Inverse propensity score-weighted multiple regression estimated a significant negative effect of labral reconstruction, relative to labral repair, on the postoperative values for the HOS-ADL (ATT, -3.3; 95% CI, -5.8 to -0.7; p = 0.012) and WOMAC (ATT, 2.6; 95% CI, 0.1 to 5.2; p = 0.044)., Conclusions: Compared with primary labral reconstruction, primary labral repair resulted in better postoperative HOS-ADL and WOMAC values and decreased conversion to THA. These findings were demonstrated in both the unadjusted group comparisons and multivariable modeling. These data support the use of labral repair in the primary setting of labral tears and the reservation of labral reconstruction for more advanced labral pathology or for revision cases., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: No external funding was received for this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I166)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Female soccer players have been identified as presenting with low energy availability (LEA), though the prevalence of LEA may be overestimated given inaccuracies associated with self-reporting dietary intakes. Accordingly, we aimed to quantify total daily energy expenditure (TDEE) via the doubly labelled water (DLW) method, energy intake (EI) and energy availability (EA). Adolescent female soccer players (n = 45; 16 ± 1 years) completed a 9-10 day 'training camp' representing their national team. Absolute and relative TDEE was 2683 ± 324 and 60 ± 7 kcal kg -1 fat free mass (FFM), respectively. Mean daily EI was lower (P < 0.01) when players self-reported using the remote food photography method (RFPM) (2047 ± 383 kcal day -1 ) over a 3-day period versus DLW derived EI estimates accounting for body mass (BM) changes (2545 ± 518 kcal day -1 ) over 7-8 days, representing a mean daily Δ of 499 ± 526 kcal day -1 and 22% error when using the RFPM. Estimated EA was different (P < 0.01) between methods (DLW: 48 ± 14 kcal kg -1 FFM, range: 22-82; RFPM: 37 ± 8 kcal kg -1 FFM, range: 22-54), such that prevalence of LEA (<30 kcal kg -1 FFM) was lower in DLW compared with RFPM (5% vs. 15%, respectively). Data demonstrate the potential to significantly underestimate EI when using self-report methods. This approach can therefore cause a misrepresentation and an over-prevalence of LEA, which is the underlying aetiology of 'relative energy deficiency in sport' (REDs). HIGHLIGHTS: What is the central question of this study? Do self-reported dietary intakes (via remote food photography method, RFPM) overestimate low energy availability (LEA) prevalence in female soccer players compared with energy intake evaluation from the doubly labelled water (DLW) method? What is the main finding and its importance? Estimated energy availability is greater with the DLW method compared with RFPM, such that the prevalence of LEA is greater when self-reporting dietary intakes. Accordingly, data demonstrate the potential to misrepresent the prevalence of LEA, an underlying factor in the aetiology of 'relative energy deficiency in sport' (REDs)., (© 2024 The Author(s). Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

Introduction: Patients who present with hemorrhage from pelvic fractures have an increased risk of mortality with prolonged time to intervention. Identifying risk factors associated with hemorrhage can expedite treatment. In this study we explore clinical and radiographic predictors for angiography in trauma patients with pelvic fractures., Method: Retrospective, single-center review between 2009 and 2019 at a level 1 trauma center of all trauma patients with pelvic fractures. We excluded patients who died prior to arrival or in the trauma bay who did not undergo computed tomography ("CT"). Finalized attending descriptions of CT findings were reviewed, including size of hematomas, and presence of extravasation. Chi-square, Mann-Whitney U and multi-variate regressions were performed., Results: We analyzed 1,703 trauma patients with pelvic fractures. Most common mechanisms of injury included MVC (45 %), fall (27 %) and motorcycle accident (12 %). 48 % (819/1703) of patients had pelvic hematomas on CT scan. 17 %(138/819) of patients with a hematoma also had evidence of extravasation. Significant predictors for extravasation on CT included large hematoma on CT, AIS extremity ≥2, binder placement, increased ISS, HR, and decreased GCS and SBP (p < 0.005). Significant predictors for angiography were similar, including AIS extremity ≥2, binder placement, presence of moderate and large hematoma and active extravasation on CT (p < 0.01). Stepwise logistic regression model incorporated ISS, HR, AIS extremity score, binder placement, and contrast extravasation with an AUC = 0.9345., Conclusion: In this large retrospective review of traumatic pelvic fractures, specific clinical and radiographic factors were significantly associated with pelvic hematomas, extravasation and/or need for angiography. Future collaborative work with orthopedics and interventional radiology is planned to better triage pelvic fracture patients and identify those at risk for bleeding that require earlier intervention., Competing Interests: Declaration of competing interest All authors declare no relevant conflicts of interest pertinent to this work. Caroline Park and Adam Starr are advisors to TraumaCare.AI., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The aim of this study was to define the minimal clinically important difference (MCID) values for patient-reported outcomes (PROs) after arthroscopic treatment of snapping scapula syndrome (SSS) using a distribution-based method, and to identify demographic, clinical, and intraoperative factors significantly associated with the achievement of MCID. It was hypothesized that subjective satisfaction scores after the procedure would be strongly associated with the achievement of MCID thresholds for the PROs and that pain, preoperative response to injection, and a scapulectomy in addition to bursal resection would be predictive of clinically relevant improvement., Methods: Patients who underwent arthroscopic treatment of SSS between October 2005 and September 2020 with a minimum of 2-year short-term postoperative follow-up were enrolled in this retrospective single-center study. The MCID was calculated using a distribution-based approach for the following PROs: 12-Item Short Form Health Survey (SF-12), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) pain "today" and "at worst." The association between achievement of the MCID and postoperative subjective satisfaction was investigated, and factors associated with achievement of MCID were determined using bivariate analysis., Results: Of a total of 190 patients assessed for eligibility, 77 patients (38.1 ± 14.3 years; 36 females) were included. Within the study population, statistically significant improvements in postoperative SF-12 physical component summary (PCS) (P < .001) and mental component summary (MCS) (P < 0.034), ASES (P < .001), QuickDASH (P < .001), SANE (P < .001), and VAS pain (P < .001) scores were observed at the minimum 2-year follow-up. The calculated MCID threshold values based on the study population were 5.0 for SF-12 PCS, 5.8 for SF-12 MCS, 11.3 for ASES, -10.5 for QuickDASH, 14.7 for SANE, 1.5 for VAS pain, and 1.7 for VAS pain at worst. Reaching the MCID was strongly associated with postoperative satisfaction (rated on a scale of 1-10). Across the PROs, younger age, favorable preoperative response to injection, partial scapuloplasty or scapulectomy, no prior surgery, and pain and function at baseline were significantly associated with attaining MCID., Conclusions: Patients who underwent arthroscopic treatment for SSS experienced clinically significant improvements in functional scores, pain, and quality of life. This study demonstrated predictive roles for certain patient-specific factors and diagnostic variables for achieving MCID in PROs, which may help surgeons preoperatively assess the probability of success and manage patient expectations., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Study Design: Retrospective multi-site cohort study., Objectives: To develop an accurate machine learning predictive model using predictor variables from the acute rehabilitation period to determine ambulatory status in spinal cord injury (SCI) one year post injury., Setting: Model SCI System (SCIMS) database between January 2000 and May 2019., Methods: Retrospective cohort study using data that were previously collected as part of the SCI Model System (SCIMS) database. A total of 4523 patients were analyzed comparing traditional models (van Middendorp and Hicks) compared to machine learning algorithms including Elastic Net Penalized Logistic Regression (ENPLR), Gradient Boosted Machine (GBM), and Artificial Neural Networks (ANN)., Results: Compared with GBM and ANN, ENPLR was determined to be the preferred model based on predictive accuracy metrics, calibration, and variable selection. The primary metric to judge discrimination was the area under the receiver operating characteristic curve (AUC). When compared to the van Middendorp all patients (0.916), ASIA A and D (0.951) and ASIA B and C (0.775) and Hicks all patients (0.89), ASIA A and D (0.934) and ASIA B and C (0.775), ENPLR demonstrated improved AUC for all patients (0.931), ASIA A and D (0.965) ASIA B and C (0.803)., Conclusions: Utilizing artificial intelligence and machine learning methods are feasible for accurately classifying outcomes in SCI and may provide improved sensitivity in identifying which individuals are less likely to ambulate and may benefit from augmentative strategies, such as neuromodulation. Future directions should include the use of additional variables to further refine these models., (© 2024. The Author(s), under exclusive licence to International Spinal Cord Society.)

Climate change is exacerbating wildfire conditions, but evidence is lacking for global trends in extreme fire activity itself. Here we identify energetically extreme wildfire events by calculating daily clusters of summed fire radiative power using 21 years of satellite data, revealing that the frequency of extreme events (≥99.99th percentile) increased by 2.2-fold from 2003 to 2023, with the last 7 years including the 6 most extreme. Although the total area burned on Earth may be declining, our study highlights that fire behaviour is worsening in several regions-particularly the boreal and temperate conifer biomes-with substantial implications for carbon storage and human exposure to wildfire disasters., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Context: Politics is characterised by power relations, and the deployment of power is inescapably political. In an increasingly globalised and interconnected modern world, politics is shaping the field of medical education more than ever before. Global frameworks that classify peoples and places are political tools that are fundamentally shaped by hegemonic knowledge systems. Despite this, they continue to form the basis for global thinking and practices, including in medical education. Political analysis can help to expose and challenge such thinking., Approach: To better understand impacts of globalisation in medical education, we explore the previously under-examined political dimensions that underpin it, focusing particularly on deconstructing power relations. We situate our analysis of global medical education in political terms, including through examination of ideology, economics, market and the enduring effects of colonialism. We interrogate the construct of the Global South (GS), considering the geopolitical and historical ideas that have enabled it to be widely propagated. We go on to examine the consequences of the GS construct in medical education and consider what this tells us about how power is enacted in the field., Conclusions: In analysing the politics of global medical education, we shed light on how power is exerted and draw attention to forces that permit and enable trends, policies and positions. Notwithstanding the emancipatory rhetoric that has been associated with the GS construct, we highlight its reductive potential and argue that it can lead to an oversimplification of power relations and vested interests. Given the growing recognition that educational approaches do not transfer well across countries and cultures, we encourage the medical education community to consider why ideas from more dominant countries continue to be imitated so routinely. In doing so, we urge them to use political lenses to recognise the influence of multiple complex and interconnected forces of global power that shape all aspects of medical education., (© 2024 The Author(s). Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

The amount of cold work induced by a surface hardening technique and the depth to which it is produced within a metallic material are both important parameters within the field of surface engineering. In this paper a methodology of establishing reliable estimates of the depth and magnitude of cold work in surface hardened nickel-based superalloy single crystals from a dataset (map) of electron backscattered diffraction images through the analysis of local misorientations is described in detail. The impact of varying a number of acquisition parameters within the scanning electron microscope and the impact of the various post-acquisition analysis parameters on the outcome of the analysis are both described and discussed in detail. The Python script used to perform this analysis is published in full. The principles and processes underlying this methodology, as well as the published script, can be readily adapted for the analysis of datasets of electron backscattered diffraction images from other surface hardening techniques and other surface-hardened materials., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Viscosity-vaso-occlusion (VVO) and haemolysis-endothelial dysfunction (HED) are pathophysiological mechanisms and clinical subphenotypes of sickle cell disease (SCD). Recurrent vaso-occlusive crises (VOC) may lead to neuroplastic changes and pain sensitization. Among 257 SCD participants, we assessed the relationship of subphenotypes with pain sensitivity using quantitative sensory testing to identify heat pain thresholds (HPT) and pressure pain thresholds (PPT). VOC history and sleep, social and emotional functioning were assessed using the adult sickle cell quality of life measurement information system. The 'elbow method' determined the optimal number of clusters as three. Clustering was performed using K-prototypes. Among clusters 2 and 3, VOC frequency and severity were higher. Clusters 1 and 3 had lower haemoglobin, higher reticulocytes and lactate dehydrogenase and more leg ulcers. In multivariate regression, cluster 3 was associated with approximately 13.6% lower PPT compared to cluster 1, and female sex was associated with decreases in PPT and HPT at the hands and feet (p < 0.001). Hydroxyurea use and unit increases in sleep functioning and age were associated with approximately 20.1% higher foot-PPT, 6.8% higher hand-PPT and 2.5% higher hand-HPT and foot-HPT respectively. Findings suggest that a third subphenotype with mixed VVO and HED features and worse pain sensitization may exist., (© 2024 British Society for Haematology and John Wiley & Sons Ltd.)

Mine industry workers (n=515) from various locations in Australia completed a questionnaire to assess the prevalence of symptoms associated with heat-related illness and water consumption habits during a summer season. Participants read from a pre-defined list and noted any heat-related symptoms that they had experienced. The most prevalent symptoms experienced were fatigue, headache, sweating, and dark coloured urine, with 77% of respondents reporting at least one symptom. Workers with shorter employment durations had higher rates of reporting multiple symptoms (rates ratios: 1.40-1.72). The most prevalent water consumption amounts over an 11-12 h shift were 2-4 L by 37.3% of total respondents, followed by 1-2 L by 36.5% of respondents. Employers should inform workers about the severe implications of heat-related illnesses, implement regular water breaks, and educate personnel about the importance of water intake. Providing employees with self-check methods of hydration status is recommended to increase awareness of their hydration status.

Background: Australia has experienced extreme fire weather in recent years. Information on the impact of fine particulate matter (PM 2.5 ) from landscape fires (LFs) on cardiorespiratory hospital admissions is limited., Methods: We conducted a population-based time series study to assess associations between modelled daily elevated PM 2.5 at a 1.5×1.5 km resolution using a modified empirical PM 2.5 exposure model during LFs and hospital admissions for all-cause and cause-specific respiratory and cardiovascular diseases for the study period (2015-2017) in Perth, Western Australia. Multivariate Poisson regressions were used to estimate cumulative risk ratios (RR) with lag effects of 0-3 days, adjusted for sociodemographic factors, weather and time., Results: All-cause hospital admissions and overall cardiovascular admissions increased significantly across each elevated PM 2.5 concentration on most lag days, with the strongest associations of 3% and 7%, respectively, at the high level of ≥12.60 µg/m 3 on lag 1 day. For asthma hospitalisation, there was an excess relative risk of up to 16% (RR 1.16, 95% CI 1.00 to 1.35) with same-day exposure for all people, up to 93% on a lag of 1 day in children and up to 52% on a lag of 3 days in low sociodemographic groups. We also observed an increase of up to 12% (RR 1.12, 95% CI 1.02 to 1.24) for arrhythmias on the same exposure day and with over 154% extra risks for angina and 12% for heart failure in disadvantaged groups., Conclusions: Exposure to elevated PM 2.5 concentrations during LFs was associated with increased risks of all-cause hospital admissions, total cardiovascular conditions, asthma and arrhythmias., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Mycobacteriophages are viruses that specifically infect bacterial species within the genera Mycobacterium and Mycolicibacterium . Over 2400 mycobacteriophages have been isolated on the host Mycolicibacterium smegmatis and sequenced. This wealth of genomic data indicates that mycobacteriophage genomes are diverse, mosaic, and contain numerous (35-60%) genes for which there is no predicted function based on sequence similarity to characterized orthologs, many of which are essential to lytic growth. To fully understand the molecular aspects of mycobacteriophage-host interactions, it is paramount to investigate the function of these genes and gene products. Here we show that the temperate mycobacteriophage, Alexphander, makes stable lysogens with a frequency of 2.8%. Alexphander gene 94 is essential for lytic infection and encodes a protein predicted to contain a C-terminal MerR family helix-turn-helix DNA-binding motif (HTH) and an N-terminal DinB/YfiT motif, a putative metal-binding motif found in stress-inducible gene products. Full-length and C-terminal gp94 constructs form high-order nucleoprotein complexes on 100-500 base pair double-stranded DNA fragments and full-length phage genomic DNA with little sequence discrimination for the DNA fragments tested. Maximum gene 94 mRNA levels are observed late in the lytic growth cycle, and gene 94 is transcribed in a message with neighboring genes 92 through 96 . We hypothesize that gp94 is an essential DNA-binding protein for Alexphander during lytic growth. We proposed that gp94 forms multiprotein complexes on DNA through cooperative interactions involving its HTH DNA-binding motif at sites throughout the phage chromosome, facilitating essential DNA transactions required for lytic propagation.

Lymphoma is a malignant tumor caused by abnormal proliferation of lymphocytes in the lymphatic system. Conventional treatments for lymphoma often have limitations, and new therapeutic strategies need to be explored. Realgar is an ancient Chinese medicine that has been used for centuries to treat a variety of ailments due to its therapeutic potential for various diseases, including cancer. However, it is a time-consuming waste and has a low absorption rate in the gastrointestinal tract, so it has the disadvantages of oral dose, potential toxicity, and low bioavailability. Recently, the development of nanotechnology has promoted the nanization of realgar particles, which have better physicochemical properties and higher bioavailability. The antitumor activity of Realgar nanoparticles against lymphoma has been demonstrated in preclinical studies. Realgar nanoparticles exhibit cytotoxic effects by inducing apoptosis and inhibiting the growth and proliferation of lymphoma cells. Moreover, these nanoparticles exert immunomodulatory effects by enhancing the activity of immune cells and promoting the cytotoxicity of T lymphocytes against lymphoma cells. Additionally, realgar nanoparticles have been shown to inhibit tumor angiogenesis, thereby restricting the blood supply and nutrient availability to lymphoma cells. Despite promising preclinical data, further research on the role and mechanism of realgar nanoparticles in the treatment of lymphoma remains to be studied. Moreover, the translation of these findings into clinical practice requires rigorous evaluation through well-designed clinical trials. Realgar nanoparticles hold great potential as a novel therapeutic approach for lymphoma, and their development may contribute to the advancement of precision medicine in the field of oncology., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: There is limited real-world data highlighting recent temporal in-hospital morbidity and mortality trends for cases of acute myocardial infarction complicated by cardiogenic shock. The role of mechanical circulatory support within this patient population remains unclear., Methods: The US National Inpatient Sample database was sampled from 2011 to 2018 identifying 206,396 hospitalizations with a primary admission diagnosis of ST- or Non-ST elevation myocardial infarction complicated by cardiogenic shock. The primary outcomes included trends of all-cause in-hospital mortality, mechanical circulatory support use, and sex-specific trends for acute myocardial infarction complicated by cardiogenic shock (AMI-CS) over the study period., Results: The annual number of AMI-CS hospitalizations increased from 22,851 in 2011 to 30,015 in 2018 and in-hospital mortality trends remained similar (42.9 % to 43.7 %, ptrend < 0.001). The proportion of patients receiving any temporary MCS device decreased (46.4 % to 44.4 %). The use of intra-aortic balloon pump (IABP) decreased (44.9 % to 32.9 %) and the use of any other non-IABP MCS device increased (2.5 % to 15.6 %), ptrend<0.001. Sex-specific mortality indicate female in-hospital mortality remained similar (50.3 % to 51 %, ptrend<0.001), but higher than male in-hospital mortality, which increased non-significantly (38.8 % to 40.2 %, ptrend = 0.372)., Conclusions: From 2011 to 2018, hospitalizations for AMI-CS patients have increased in number. However, there has been no recent appreciable change in AMI-CS mortality despite a changing treatment landscape with decreasing use of IABPs and increasing use of non-IABP MCS devices. Further research is necessary to examine the appropriate use of MCS devices within this population., Competing Interests: Declaration of competing interest None. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no other financial or personal relationships with other people or organizations to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The outpatient parenteral antibiotic therapy (OPAT) program of Vancouver General Hospital (VGH) was supervised by emergency physicians (EPs) until 2017 when infectious disease (ID) physicians began assisting in management. We designed a retrospective study to determine whether ID involvement led to improved outcomes., Methods: This study analyzes the impact of ID involvement by comparing the mean days patients spent on OPAT with ID involvement versus EPs alone through a retrospective chart review. Secondary research objectives were to compare patient care decisions, e.g., antibiotic choice, tests ordered, and final diagnosis., Results: There was no difference between the mean number of days on OPAT between physician types. Compared to historic patterns, patients seen in OPAT after increased ID consultation spent an average of 0.5 fewer days in the program. However, when grouped by the first day of ID assessment, the average total days in OPAT was closely aligned with the day of first ID assessment, implying that ID frequently discharged patients close to initial assessment. Patients seen by ID were less likely to return within one month of discharge compared to those not seen by ID. Secondary findings include ID physicians prescribing a greater range of antibiotics, providing more varied final diagnoses, prescribing antibiotics less frequently, as well as ordering more cultures, diagnostic imaging and specialist consults., Discussion: The findings of this study support the hypothesis that ID involvement in OPAT programs leads to changes in care that may have beneficial outcomes for patients and the healthcare system., (© 2024. The Author(s).)

Decision-making deficits, assessed cognitively, are often associated with mental health symptoms, however, this relationship is not fully understood. This paper explores the relationship between mental health disorders and decision-making, using the Cambridge Gambling Task (CGT). Our study investigated how decision-making varied across 20 different mental health conditions compared to controls in a sample of 572 young adults from the Minneapolis and Chicago metropolitan areas, using a computerized laboratory-based task. Almost all mental health conditions were associated with at least mild (i.e. at least small effect size) impairment in all three studied parameters of the CGT (risk adjustment, quality of decision-making and overall proportion of bet). Notably, binge eating disorder had the largest cognitive impairment and gambling disorder had moderate impairment. Post-traumatic stress disorder (PTSD) was associated with impaired decision-making while obsessive-compulsive disorder (OCD) and depression showed moderate impairment. Additionally, half of the disorders assessed had moderate to large impairment in risk adjustment.These findings suggest that mental health conditions may have a more complex cognitive profile than previously thought, and a better understanding of these impairments may aid in risk assessment and targeted clinical interventions. This study underscores the need for further research to determine the causal pathways between mental health conditions and cognition, as well as to better understand the day-to-day impact of such deficits.

Background: For breast cancer with advanced regional lymph node involvement, axillary lymph node dissection (ALND) remains the standard of care for staging and treating the axilla despite the presence of undissected lymph nodes. The benefit of ALND in this setting is unknown., Objectives: We sought to describe national patterns of care of axillary surgery and its association with overall survival (OS) among women with cN2b-N3c breast cancer who receive adjuvant radiotherapy., Patients and Methods: We identified female patients with cN2b-N3c breast cancer from 2012 to 2017 from the National Cancer Database. Clinical and demographic information were analyzed using Wilcoxon rank sum and χ 2 tests. Predictors of receipt of ALND and predictors of death were identified with multivariable logistic regression modeling. Inverse probability of treatment weighting was implemented to adjust for differences in treatment cohorts. The Kaplan-Meier method was used to evaluate OS., Results: We identified 7167 patients. Of these, 922 (13%) received SLNB and 6254 (87%) received ALND; 7% were cN2b, 19% cN3a, 24% cN3b, 19% cN3c, and 31% cN3, not otherwise specified. Predictors of receipt of ALND were age 50-69 years [odds ratio (OR) 1.3, p < 0.01], cN3a (OR 7.6, p < 0.01), cN3b (OR 2.8, p < 0.01), and cN3c (OR 4.2, p < 0.01). Predictors of death included cN3c (OR 1.9, p < 0.01), age 70-90 years (OR 1.5, p = 0.01), and positive surgical margins (OR 1.5, p < 0.01). After cohort balancing, ALND was not associated with improved OS when compared with SLNB (HR 0.99, p = 0.91)., Conclusions: ALND in patients with advanced nodal disease was not associated with improved survival compared with SLNB for women who receive adjuvant radiotherapy., (© 2024. Society of Surgical Oncology.)

This research involved an evaluation of the Nutrition and Body Mass Index Clinical Link Pathway (NBMI CLiP) implemented in practice across Severe Mental Illness and/or learning disabilities ward in Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), to understand how the NBMI CLiP is used, inpatient staff feedback on the CLiP for supporting service users to manage their weight, and whether using the NBMI CLiP impacted on staffs' own weight management. To account for the uneven distribution of the secondary data, descriptive statistics such as medians and the inter-quartile range were conducted to assess anychanges in recording of Body Mass Index, nutrition screening (SANSI) and intervention planss. Staff survey data investigated barriers and facilitators to using the NBMI CLiP in practice and the impact on their own weight management. Secondary data analysis found most wards improved recording of BMI, SANSI and Intervention Planning. Forensic Learning Disabilities, Adult Learning Disabilities, mixed gender wards and North Yorkshire and York Operational Directorate indicated the greatest improvement. Survey results (n = 55) found three times as many participants (n = 12, 75%) found the NBMI CLiP easy or very easy to use; most fully understood it (n = 13, 81.20%) and were confident or very confident to carry out a SANSI Screen (n = 14, 87.50%) or a recovery focused intervention plan (n = 9, 56.20%). Open-text responses, analysed using content analysis, indicated a need for further training of staff on the NBMI CLiP. It is recommended that to support weight management across these wards, that a nudge or choice architecture approach to weight management is adopted, supported by training delivered by a dietitian., Competing Interests: At the time of the study Jo Smith was employed by Tees, Esk and Wear Valleys NHS Foundation Trust as Consultant Dietitian. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Giles et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Local protein synthesis in axons and dendrites underpins synaptic plasticity. However, the composition of the protein synthesis machinery in distal neuronal processes and the mechanisms for its activity-driven deployment to local translation sites remain unclear. Here, we employed cryo-electron tomography, volume electron microscopy, and live-cell imaging to identify Ribosome-Associated Vesicles (RAVs) as a dynamic platform for moving ribosomes to distal processes. Stimulation via chemically-induced long-term potentiation causes RAV accumulation in distal sites to drive local translation. We also demonstrate activity-driven changes in RAV generation and dynamics in vivo , identifying tubular ER shaping proteins in RAV biogenesis. Together, our work identifies a mechanism for ribosomal delivery to distal sites in neurons to promote activity-dependent local translation., Competing Interests: Competing interests: The authors declare that they have no competing interests.

Evidence accumulation models (EAMs) have become the dominant theoretical framework for rapid decision-making, and while many theoretically distinct variants exist, comparisons have proved challenging due to strong mimicry in their predictions about choice response time data. One solution to reduce mimicry is constraining these models with double responses, which are a second response that is made after the initial response. However, instructing participants that they are allowed to change their mind could influence their strategy for initial responding, meaning that explicit double responding paradigms may not generalise to standard paradigms. Here, we provide a validation of explicit double responding paradigms, by assessing whether participants' initial decisions - as measured by diffusion model parameters - differ based on whether or not they were instructed that they could change their response after their initial response. Across three experiments, our results consistently indicate that allowing for changes of mind does not influence initial responses, with Bayesian analyses providing at least moderate evidence in favour of the null in all cases. Our findings suggest that explicit double responding paradigms should generalise to standard paradigms, validating the use of explicit double responding in future rapid decision-making studies., (© 2023. The Psychonomic Society, Inc.)

Coevolution between interacting species is thought to increase biodiversity, but evidence linking microevolutionary processes to macroevolutionary patterns is scarce. We leveraged two decades of behavioral research coupled with historical DNA analysis to reveal that coevolution with hosts underpins speciation in brood-parasitic bronze-cuckoos. At a macroevolutionary scale, we show that highly virulent brood-parasitic taxa have higher speciation rates and are more likely to speciate in sympatry than less-virulent and nonparasitic relatives. We reveal the microevolutionary process underlying speciation: Hosts reject cuckoo nestlings, which selects for mimetic cuckoo nestling morphology. Where cuckoos exploit multiple hosts, selection for mimicry drives genetic and phenotypic divergence corresponding to host preference, even in sympatry. Our work elucidates perhaps the most common, but poorly characterized, evolutionary process driving biological diversification.

Despite the success of surface-enhanced Raman spectroscopy (SERS) for detecting DNA immobilized on plasmonic metal surfaces, its quantitative response is limited by the rapid falloff of enhancement with distance from the metal surface and variations in sensitivity that depend on orientation and proximity to plasmonic "hot spots". In this work, we assess an alternative approach for enhancing detection by immobilizing DNA on the interior surfaces of porous silica particles. These substrates provide over a 1000-fold greater surface area for detection compared to a planar support. The porous silica substrate is a purely dielectric material with randomly oriented internal surfaces, where scattering is independent of proximity and orientation of oligonucleotides relative to the silica surface. We characterize the quantitative response of Raman scattering from DNA in porous silica particles with sequences used in previous SERS investigations of DNA for comparison. The results show that Raman scattering of DNA in porous silica is independent of distance of nucleotides from the silica surface, allowing detection of longer DNA strands with constant sensitivity. The surface area enhancement within particles is reproducible (<4% particle-to-particle variation) owing to the uniform internal pore structure and surface chemistry of the silica support. DNA immobilization with a bis-thiosuccinimide linker provides a Raman-active internal standard for quantitative interpretation of Raman scattering results. Despite the high (30 mM) concentrations of immobilized DNA within porous silica particles, they can be used to measure nanomolar binding affinities of target molecules to DNA by equilibrating a very small number of particles with a sufficiently large volume of low-concentration solution of target molecules.

In this study, we explore the utilization of penalized likelihood estimation for the analysis of sparse photon counting data obtained from distributed target lidar systems. Specifically, we adapt the Poisson Total Variation processing technique to cater to this application. By assuming a Poisson noise model for the photon count observations, our approach yields denoised estimates of backscatter photon flux and related parameters. This facilitates the processing of raw photon counting signals with exceptionally high temporal and range resolutions (demonstrated here to 50 Hz and 75 cm resolutions), including data acquired through time-correlated single photon counting, without significant sacrifice of resolution. Through examination involving both simulated and real-world 2D atmospheric data, our method consistently demonstrates superior accuracy in signal recovery compared to the conventional histogram-based approach commonly employed in distributed target lidar applications., (© 2024. The Author(s).)

This study assessed the effect of season on cognitive function and psycho-physiological responses during a 14-day swing in mine-service workers. Cognitive function, thermal sensation and comfort, rating of perceived exertion, fatigue, hydration, core temperature and heart rate were assessed throughout a shift, on three separate days over a swing. Working memory and processing efficiency did not differ between seasons (p > 0.05), however counting and recall latencies improved throughout the swing (p < 0.05). Participants reported greater fatigue post-shift compared to pre-shift (p < 0.05). Thermal sensation, thermal comfort, and hydration were significantly elevated in summer compared to winter (p < 0.05). Specifically, workers were significantly/minimally dehydrated in summer/winter (urinary specific gravity = 1.025 ± 0.007/1.018 ± 0.007). Although cognitive function and thermal strain were not impaired in summer compared to winter, it is essential to reinforce worker's knowledge regarding hydration requirements. Additional education and/or incorporating scheduled rest breaks for hydration should be considered to ensure the health and safety of mine workers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Advanced hybrid closed-loop (AHCL) therapy with the Medtronic MiniMed™ 780G system improves glycemia; however, the clinical outcomes in younger children remain less established. This pilot study aimed to explore the continuous glucose monitoring (CGM) metrics in very young children on AHCL. Children between 2 and 7 years of age and on insulin pump therapy were recruited. A 2-week phase in manual mode was followed by a 6-week AHCL phase. CGM metrics were analyzed to review glycemic outcomes. Out of 11 participants enrolled [mean (standard deviation [SD]) age 5.3 (0.8) years], 10 completed the study. Time in closed loop was 96.7 (3.9)%. In AHCL, participants had a mean (SD) time in range of 72.6 (7.4)% and spent 3.0 (1.74)% and 0.63 (0.46)% in time <70 and <54 mg/dL, respectively. AHCL is a feasible option for management of young children with type 1 diabetes.

Background: Chronic, low-intensity air pollution exposure has been consistently associated with increased atherosclerosis in adults. However, there was limited research regarding the implications of acute, high-intensity air pollution exposure during childhood. We aimed to determine whether there were any associations between early-life exposure to such an episode and early-life vascular function changes., Methods: We conducted a prospective cohort study of children (<9 years old) who lived in the vicinity of the Hazelwood coal mine fire (n = 206). Vascular function was measured using noninvasive diagnostic methods including carotid intima-media thickness and pulse wave velocity (PWV). Exposure estimates were calculated from prognostic models and location diaries during the exposure period completed by each participant's parent. Linear mixed-effects models were used to determine whether there were any associations between exposure and changes in vascular outcomes at the 3- and 7-year follow-ups and over time., Results: At the 7-year follow-up, each 10 μg/m 3 increase in daily PM 2.5 in utero was associated with increased PWV ( β = 0.13 m/s; 95% confidence interval [CI] = 0.02, 0.24; P = 0.02). The association between in utero exposure to daily PM 2.5 was not altered by adjustment for covariates, body mass index, and maternal fire stress. Each 1 µg/m 3 increase in background PM 2.5 was associated with increased PWV ( β = 0.68 m/s; 95% CI = 0.10, 1.26; P = 0.025), in children from the in utero exposure group. There was a trend toward smaller PWV ( β = -0.17 m/s; 95% CI = -0.366, 0.02) from the 3- to 7-year follow-up clinic suggesting that the deficits observed previously in children exposed postnatally did not persist., Conclusion: There was a moderate improvement in vascular stiffness of children exposed to PM 2.5 from a local coal mine fire in infancy. There was a mild increase in vascular stiffness in children exposed to PM 2.5 from a local coal mine fire while their mothers were pregnant., Competing Interests: E.J.H., A.B., S.A., A.J.W., M.D., G.J.W., C.X.G., K.N., F.H.J., and G.R.Z. declare that they have no conflicts of interest with regard to the content of this report. M.J.A. reports a relationship with Pfizer Global Research and Development that includes funding grants. M.J.A. reports a relationship with Boehringer Ingelheim GmbH that includes funding grants. M.J.A. reports a relationship with Sanofi Australia that includes consulting or advisory, and funding grants. M.J.A. reports a relationship with GlaxoSmithKline that includes funding grants and speaking and lecture fees., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Environmental Epidemiology. All rights reserved.)

Background: Internet interventions for common mental disorders are widely available, effective, and economical, yet community uptake remains low. One consistently cited reason for not engaging in mental health interventions is lack of time., Aims: This research examined whether lack of time as a rationale for not using online interventions reflects real time scarcity, and whether time availability impacts intention to use interventions., Methods: A nationally representative sample ( N  = 1094, 51% women) reported their time use in activity categories for a typical week. Participants rated their acceptance and likelihood of use of mental health internet interventions, and completed mental health symptom, help-seeking and stigma measures., Results: Amount of leisure time reported by participants was not associated with acceptance or likelihood of use of internet interventions for mental health. However, respondents who worked longer hours ranked time and effort factors as more influential in their intention to use internet-based mental health programs. Younger respondents and those with greater help-seeking attitudes reported higher acceptance of use., Conclusion: These findings suggest lack of time is not a direct barrier to use of internet interventions, and that perceived time scarcity may be masking real barriers to uptake.

Background and Objective: Chronic, low-intensity air pollution exposure has been consistently associated with reduced lung function throughout childhood. However, there is limited research regarding the implications of acute, high-intensity air pollution exposure. We aimed to determine whether there were any associations between early life exposure to such an episode and lung growth trajectories., Methods: We conducted a prospective cohort study of children who lived in the vicinity of the Hazelwood coalmine fire. Lung function was measured using respiratory oscillometry. Z-scores were calculated for resistance (R 5 ) and reactance at 5 Hz (X 5 ) and area under the reactance curve (AX). Two sets of analyses were conducted: (i) linear regression to assess the cross-sectional relationship between post-natal exposure to mine fire-related particulate matter with an aerodynamic diameter of less than 2.5 micrometres (PM 2.5 ) and lung function at the 7-year follow-up and (ii) linear mixed-effects models to determine whether there was any association between exposure and changes in lung function between the 3- and 7-year follow-ups., Results: There were no associations between mine fire-related PM 2.5 and any of the lung function measures, 7-years later. There were moderate improvements in X 5 (β: -0.37 [-0.64, -0.10] p = 0.009) and AX (β: -0.40 [-0.72, -0.08] p = 0.014), between the 3- and 7-year follow-ups that were associated with mean PM 2.5 , in the unadjusted and covariance-adjusted models. Similar trends were observed with maximum PM 2.5 ., Conclusion: There was a moderate improvement in lung stiffness of children exposed to PM 2.5 from a local coalmine fire in infancy, consistent with an early deficit in lung function at 3-years after the fire that had resolved by 7-years., (© 2024 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.)

Study Design: Survey., Objective: In March of 2020, an original study by Louie et al investigated the impact of COVID-19 on 902 spine surgeons internationally. Since then, due to varying government responses and public health initiatives to the pandemic, individual countries and regions of the world have been affected differently. Therefore, this follow-up study aimed to assess how the COVID-19 impact on spine surgeons has changed 1 year later., Methods: A repeat, multi-dimensional, 90-item survey written in English was distributed to spine surgeons worldwide via email to the AO Spine membership who agreed to receive surveys. Questions were categorized into the following domains: demographics, COVID-19 observations, preparedness, personal impact, patient care, and future perceptions., Results: Basic respondent demographics, such as gender, age, home demographics, medical comorbidities, practice type, and years since training completion, were similar to those of the original 2020 survey. Significant differences between groups included reasons for COVID testing, opinions of media coverage, hospital unemployment, likelihood to be performing elective surgery, percentage of cases cancelled, percentage of personal income, sick leave, personal time allocation, stress coping mechanisms, and the belief that future guidelines were needed (P<.05)., Conclusion: Compared to baseline results collected at the beginning of the COVID-19 pandemic in 2020, significant differences in various domains related to COVID-19 perceptions, hospital preparedness, practice impact, personal impact, and future perceptions have developed. Follow-up assessment of spine surgeons has further indicated that telemedicine and virtual education are mainstays. Such findings may help to inform and manage expectations and responses to any future outbreaks., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Technology use in type 1 diabetes (T1D) is impacted by socioeconomic status (SES). This analysis explored relationships between SES, glycemic outcomes, and technology use., Research Design and Methods: A cross-sectional analysis of HbA1c data from 2,822 Australian youth with T1D was undertaken. Residential postcodes were used to assign SES based on the Index of Relative Socio-Economic Disadvantage (IRSD). Linear regression models were used to evaluate associations among IRSD quintile, HbA1c, and management regimen., Results: Insulin pump therapy, continuous glucose monitoring, and their concurrent use were associated with lower mean HbA1c across all IRSD quintiles (P < 0.001). There was no interaction between technology use and IRSD quintile on HbA1c (P = 0.624), reflecting a similar association of lower HbA1c with technology use across all IRSD quintiles., Conclusions: Technology use was associated with lower HbA1c across all socioeconomic backgrounds. Socioeconomic disadvantage does not preclude glycemic benefits of diabetes technologies, highlighting the need to remove barriers to technology access., (© 2024 by the American Diabetes Association.)