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Digital food marketing (DFM) of unhealthy foods and beverages (high in saturated fats, sugar and salt) to children and young people influences brand recall, recognition, purchase intentions and attitudes, and increases consumption of unhealthy foods and beverages. Understanding children's and parents' awareness of, and attitudes toward, such marketing is crucial for developing health-promoting advocacy and policy solutions. This registered systematic scoping review synthesized literature on children's, young people's and parents' attitudes and awareness of DFM. A structured search of Medline, PsycInfo, Academic Search Complete (Ebscohost), Scopus and CINAHL was conducted. Inclusion criteria were peer-reviewed studies focused on children (<18 years), young people (<24 years) or parents, published after 2000, examining attitudes or awareness of online marketing of food or non-alcoholic beverages. Data were extracted and charted in Excel. Forty studies were included for synthesis. Studies of children/young people (n = 31) show varying levels of awareness regarding DFM on social media and other digital media. While some understand social media marketing tactics, others struggle to recognize ads. Preferences lean towards influencer marketing and 'native' advertising styles. There is limited evidence on parents' views (n = 9 studies), but these suggest low parental awareness of digital marketing tactics targeting children, and unclear opinions on regulation. Overall, the findings suggest a need for a versatile, trans-disciplinary research and advocacy agenda to capture the complex and rapidly evolving digital marketing landscape, enhance critical digital literacies (including power inequalities) for both children and parents, increase knowledge-sharing and advocacy, and develop regulatory policies., (© The Author(s) 2025. Published by Oxford University Press.)

Purpose of Review: Focused review highlighting ten select studies presented at the 2024 American Heart Association (AHA) Scientific Sessions., Recent Finding: Included studies assessed effects of intensive blood pressure control in patients with type 2 diabetes (BPROAD); decision support system for physicians to optimize early lipid lowering therapies after acute coronary syndrome (ZODIAC); efficacy and safety of zerlasiran, a short interfering RNA targeting lipoprotein(a) (ALPACAR); efficacy and safety of muvalaplin an oral disrupter of the assembly of lipoprotein(a) particles (KRAKEN); safety and efficacy of obicetrapib in patients with heterozygous familial hypercholesterolemia (BROOKLYN); efficacy and safety of lerodalcibep, a third generation PCSK9 inhibitor in heterozygous familial hypercholesterolemia subjects (LIBerate-HeFH&#95;OLE); personalized app-based coaching to improve physical activity in patients with HFpEF compared to standard care (MyoMobile); semaglutide to improve cardiovascular outcomes in patients with a history of coronary artery bypass surgery and overweight or obesity (the SELECT trial); efficacy and safety of plozasiran in adults with genetically or clinically defined familial chylomicronemia syndrome at high risk of acute pancreatitis (PALISADE); and transcriptomic signatures and predictors of evolocumab added to maximum statin therapy based on intra-coronary plaque characteristics (YELLOW III). Research presented at the 2024 AHA Scientific Sessions emphasized innovative strategies in cardiovascular disease prevention and management., Competing Interests: Declarations. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors. Competing Interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Study Question: What are the clinical and ethical challenges of performing ovarian stimulation and oocyte cryopreservation in adolescents and the barriers to providing treatment?, Summary Answer: Our study shows that, in one of the largest case series to date in this population, post-pubertal adolescents as young as age 13 years can undergo ovarian stimulation and oocyte cryopreservation with a response comparable to adults., What Is Known Already: Fertility preservation in adolescents has not been well studied, with little data available in the existing literature. Referrals for fertility preservation in adolescents are increasing due to developments in childhood cancer treatments, which have led to a growing population of children at risk of developing premature ovarian insufficiency. Those with certain benign conditions or gender incongruence also face this challenge. All established fertility preservation guidelines state that where there is a risk to fertility, oocyte cryopreservation should be offered to post-pubertal females. However, counselling and consenting young people about fertility decisions is an ethically complex area, and assessing capacity to consent in this age group is not straightforward., Study Design Size Duration: This was a retrospective observational cohort study of 182 referrals for fertility preservation counselling to a specialist unit, and we present outcomes for the 33 adolescents who underwent 36 cycles of ovarian stimulation and oocyte cryopreservation between January 2018 and January 2024., Participants/materials Setting Methods: We included patients aged 13-18 years who underwent ovarian stimulation and oocyte cryopreservation for fertility preservation due to high or intermediate risk of gonadotoxicity from medical or surgical treatment at a public-funded specialist unit. The primary outcome was oocyte yield; secondary outcomes included oocyte maturity rate, complications, and dropout rate. Data were retrieved from a prospectively managed database., Main Results and the Role of Chance: There was a total of 182 referrals received, and of these, 33 patients underwent 36 cycles of ovarian stimulation and oocyte cryopreservation. Indications for fertility preservation included malignancy n  = 19/36 (54%), ovarian cyst surgery n  = 7/36 (19%), immunological disorders n  = 4/36 (11%), benign haematological disease n  = 2/36 (6%), gender reassignment treatment n  = 3/36 (8%), and genetic conditions n  = 1/36 (3%). The youngest child who underwent ovarian stimulation was aged 13 years and 10 months at the time of egg collection; the minimum time from menarche to ovarian stimulation was 4 months, the median AMH (anti-Müllerian hormone) was 16.7 pmol/l (range 2.8-36.9 pmol/l), and the antral follicle count (AFC) was 11 (3-36). The median number of cryopreserved oocytes was 14 (range 4-39), and the oocyte maturity rate was 85% (35-100%). Ultrasound monitoring was performed transabdominally in 5/33 (15%) and transvaginally in 28/33 (85%). Egg collection was performed transvaginally in all cases in this cohort. All cycles proceeded to completion. All adolescents were counselled in association with a family member to obtain informed consent, and all were assessed as able to comprehend discussions., Limitations Reasons for Caution: In view of concerns regarding increased aneuploidy rates in this age group compared to women in their twenties, there is a need for long-term outcome studies expanding on our findings with data on livebirths to support clinicians needing to counsel patients and perform oocyte cryopreservation in adolescents., Wider Implications of the Findings: Clinician experience, correct setting, and availability of funding will enable a permissive environment for oocyte cryopreservation in adolescents. In our experience, transvaginal egg collection is an accepted procedure when counselled appropriately., Study Funding/competing Interests: No funding was received for this work. No competing interests are declared., Trial Registration Number: N/A., Competing Interests: None declared., (© The Author(s) 2025. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)

People living with HIV who experience stigma in healthcare settings are at increased risk for engaging in health avoidance behaviours, suboptimal adherence to antiretroviral therapy, and viral non-suppression. HIV-related stigma erodes trust between patients and healthcare providers, thereby undermining both individual and public health. This study aimed to identify predictors of stigmatising attitudes, stigma practices, and fear of occupational transmission among healthcare workers in the Republic of Ireland. Data were collected from 295 healthcare workers using a standardised tool designed to measure HIV-related stigma. The outcomes examined were stigmatising attitudes, stigmatising practices (such as excessive infection precaution measures), and fear of occupational transmission. Multiple linear regression analyses were conducted to explore predictors at the individual, clinic, and policy levels. The results indicated that none of the models significantly predicted stigmatising attitudes. However, stigmatising practices were positively associated with never having worked in an HIV clinic, lack of knowledge or agreement with the concept of 'undetectable equals untransmittable' (U = U), and the presence of institutional policies, collectively accounting for 25.3% of the variance. Fear of occupational transmission was positively predicted by gender and lack of knowledge or agreement with U = U, explaining 23.8% of the variance. The findings highlight the critical role of U = U knowledge in reducing stigma-related behaviours and fears among healthcare workers. Enhancing knowledge and acceptance of U = U as part of comprehensive stigma interventions may help reduce the stigma experienced by people living with HIV in healthcare settings., Competing Interests: Declarations. Conflict of Interest: The authors have no conflict of interest to report., (© 2024. The Author(s).)

Competing Interests: Conflicts of interest The authors declare no conflicts of interest.

Introduction and Objectives: The HepHIV 2023 Conference, held in Madrid in November 2023, highlighted how Europe is not on track to meet the United Nations (UN) sustainable development goals and Joint UN Programme on HIV/AIDS (UNAIDS) targets. This article presents the outcomes of the conference, which focus on ways to improve testing and linkage to care for HIV, viral hepatitis, and other sexually transmitted infections. HIV-related stigma and discrimination, a major barrier to progress, was a key concept of the conference and on the agenda of the Spanish Presidency of the European Union., Methods: The HepHIV 2023 organizing committee, alongside the Spanish Ministry of Health, oversaw the conference organization and prepared the scientific programme based on abstract rankings. Key outcomes are derived from conference presentations and discussions., Results: Conference presentations covered the obstacles that HIV-related stigma and discrimination continue to pose to access to services, models for data collection to better monitor progress in the future, and examples of legislative action that can be taken at national levels. Diversification of testing approaches was also highlighted, to reach key populations, (e.g. migrant populations), to increase testing offered in healthcare settings (e.g. emergency departments), and to account for different stages of epidemics across the region., Conclusion: With a strong call for intensified action to address the impact of HIV-related stigma and discrimination on testing uptake, the conference concluded that strengthened collaboration is required between governments and implementers around testing and linkage to care. There is also an ongoing need to ensure sustainable political commitment and appropriate resource allocation to address gaps and inequalities in access for key populations and to focus on the implementation of integrated responses to HIV, viral hepatitis, and sexually transmitted infections., (© 2024 The Author(s). HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)

Purpose of Review: While primary prevention strategies target individuals who are at high risk of cardiovascular disease, there is rising interest towards primordial prevention that focuses on preventing the development of risk factors upstream of disease detection. Therefore, we review the advantages of primordial prevention interventions on minimizing future cardiovascular events., Recent Findings: Primordial prevention of atherosclerotic cardiovascular disease involves behavioral, genetic, and environmental strategies, starting from fetal/infant health and continuing throughout childhood and young adulthood. Early interventions focusing on modifiable risk factors such as physical inactivity, non-ideal body weight, smoking, and environmental pollutants are important towards preventing the initial occurrence of risk factors such as hypertension, dyslipidemia, and diabetes to ultimately reduce cardiovascular disease. Implementing primordial prevention strategies early on in life can minimize cardiovascular events and lead to healthy aging in the population. Future studies can further evaluate the effectiveness of various primordial prevention strategies., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Awareness of issues and health concerns can prompt individuals to change their lifestyle behaviors. In fact, awareness is typically one of the first steps towards behavior change. However, awareness alone does not necessarily initiate or sustain behavioral changes. Specifically, many individuals experience significant barriers that prevent behavior change. Providers can address such barriers through ecological models of behavior change. Including concepts from an ecological model in health care settings can support positive lifestyle behavior change post-diagnosis. Moving beyond awareness alone and addressing barriers to change is an important goal that ultimately increases the probability of change for patients., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 The Author(s).)

Drug-induced kidney injury (DIKI) refers to kidney damage resulting from the administration of medications. The aim of this project was to identify reliable urinary microRNA (miRNAs) biomarkers that can be used as potential predictors of DIKI before disease diagnosis. This study quantified a panel of six miRNAs (miRs-210-3p, 423-5p, 143-3p, 130b-3p, 486-5p, 193a-3p) across multiple time points using urinary samples from a previous investigation evaluating effects of a nephrotoxicant in cynomolgus monkeys. Exosome-associated miRNA exhibited distinctive trends when compared to miRNAs quantified in whole urine, which may reflect a different urinary excretion mechanism of miRNAs than those released passively into the urine. Although further research and mechanistic studies are required to elucidate how these miRNAs regulate signaling in disease pathways, we present, for the first time, data that several miRNAs displayed strong correlations with histopathology scores, thus indicating their potential use as biomarkers to predict the development of DIKI in preclinical studies and clinical trials. Also, these findings can potentially be translated into other non-clinical species or human for the detection of DIKI., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The following authors are employed in the pharmaceutical industries (at the time of article submission): P.K.M., B.B., A.E., E.V., T.S., D.D.W., A.S, T.R.V. The opinions presented here are those of the authors. 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 The Authors. Published by Elsevier Inc. All rights reserved.)

Sleep quality is essential to biopsychosocial functioning, yet there remains limited longitudinal research on sleep and mental or social well-being within low- or middle-income countries. This study utilised longitudinal cohort data from a community-based empowerment programme in Meru County, Kenya to assess cross-lagged correlations between sleep disturbance, social support, symptoms of depression, anxiety, and posttraumatic stress. Participants (n = 373; 92% women; age range 18-86 years) who reported more sleep disturbance at T1 reported significantly more symptoms of depression, anxiety, and PTSD, and significantly less social support at T2 (average 11 weeks later), controlling for all within-time correlations across measures, within-measure correlations across time, and sociodemographic background characteristics. The findings are consistent with research across high-income countries, underscoring the need for more contextualised research into sleep behaviours across low- and middle-income countries. The findings may inform interventions to increase mental and social well-being within Kenya., (© 2023 European Sleep Research Society.)

Cell-based medicinal products (CBMPs) are a growing class of therapeutics that promise new treatments for complex and rare diseases. Given the inherent complexity of the whole human cells comprising CBMPs, there is a need for robust and fast analytical methods for characterization, process monitoring, and quality control (QC) testing during their manufacture. Existing techniques to evaluate and monitor cell quality typically constitute labor-intensive, expensive, and highly specific staining assays. In this work, we combine image-based deep learning with flow imaging microscopy (FIM) to predict cell health metrics using cellular morphology "fingerprints" extracted from images of unstained Jurkat cells (immortalized human T-lymphocyte cells). A supervised (i.e., algorithm trained with human-generated labels for images) fingerprinting algorithm, trained on images of unstained healthy and dead cells, provides a robust stain-free, non-invasive, and non-destructive method for determining cell viability. Results from the stain-free method are in good agreement with traditional stain-based cytometric viability measurements. Additionally, when trained with images of healthy cells, dead cells and cells undergoing chemically induced apoptosis, the supervised fingerprinting algorithm is able to distinguish between the three cell states, and the results are independent of specific treatments or signaling pathways. We then show that an unsupervised variational autoencoder (VAE) algorithm trained on the same images, but without human-generated labels, is able to distinguish between samples of healthy, dead and apoptotic cells along with cellular debris based on learned morphological features and without human input. With this, we demonstrate that VAEs are a powerful exploratory technique that can be used as a process monitoring analytical tool., (Copyright © 2024 American Pharmacists Association. Published by Elsevier Inc. All rights reserved.)

Black carbon (BC) can comprise a significant fraction of the soil carbon pool in cities. However, vegetation cover and human activity influence the spatial distribution of urban soil BC. We quantified soil total carbon (TC), soil organic carbon (SOC), BC, and total nitrogen (TN) in a medium-sized city in Dallas-Fort Worth, Texas. Soils were sampled to 20 cm depth from underneath 16 paired Quercus stellata (post oak) trees and open lawns. Effects of vegetation cover, road density, and building age (a proxy for time since development) on soil C and N were analyzed. Soil OC concentrations were higher under post oak trees (5.5%) compared to open lawns (3.6%) at 0-10 cm, but not at 10-20 cm depth. In contrast, soil BC and TN did not differ by vegetation cover. There were significant interaction effects between vegetation cover and road density and vegetation cover and building age on soil BC. At 0-10 cm, soil BC concentrations, stock, and BC/SOC ratios increased more with road density under trees than lawns, indicating enhanced atmospheric BC deposition to tree canopies. Black carbon in tree soils also increased with building age as compared to lawn soils, likely due to higher BC retention under trees, enhanced BC losses under lawns, or both. Our findings show that urban tree soils are localized opportunity hotspots for BC storage in areas with elevated emissions and longer time since development. Conserving and planting urban trees above permeable surfaces and soils could contribute to long-term carbon storage in urban ecosystems., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: We examined the association between electronic health information sharing and repeat imaging in readmissions among older adults with and without Alzheimer disease (AD)., Study Design: Cohort study using national Medicare data., Methods: Among Medicare beneficiaries with 30-day readmissions in 2018, we examined repeat imaging on the same body system during the readmission. This was evaluated between fragmented and nonfragmented (same-hospital) readmissions and across categories of electronic information sharing via health information exchanges (HIEs) in fragmented readmissions: admission and readmission hospitals share the same HIE, admission and readmission hospitals participate in different HIEs, one or both do not participate in HIE, or HIE data missing. This relationship was evaluated using unadjusted and adjusted logistic regression., Results: Overall, 14.3% of beneficiaries experienced repeat imaging during their readmission. Compared with nonfragmented readmissions, fragmented readmissions were associated with 5% higher odds of repeat imaging on the same body system in older adults without AD. This was not mitigated by the presence of electronic information sharing: Fragmented readmissions to hospitals that shared an HIE had 6% higher odds of repeat imaging (adjusted OR, 1.06; 95% CI, 1.00-1.13). There was no difference seen in the odds of repeat imaging for older adults with AD., Conclusions: Despite substantial investment, HIEs as currently deployed and used are not associated with decreased odds of repeat imaging in readmissions.

The method of photovoice has been previously used to effectively engage with socioeconomically disadvantaged groups and explore their eating behaviours. In this methodological article, we draw on our experiences from using photovoice through online interviews with families on low income about their food decisions. A purposive recruitment approach targeted parents of children 2-17 years old who lived on a tight budget across the island of Ireland. Participants provided demographic information and were invited to take photographs of food-related decisions and activities for 1 week during the COVID-19 lockdown. The photographs were then discussed through an online communication platform to generate qualitative data. A total of 28 parents participated in the photo-elicited interviews and shared a total of 642 photographs of factors that influenced their food decisions. Following the interviews, the researchers documented their reflections which focused on (1) participants' engagement with the online photo-elicitation and (2) practical aspects around participant consent and data safety. The participants in our study engaged well with the online photovoice method and shared a variety of photos which provided ample material to facilitate the conversations around their food environment and its impact on their food decisions. Our experiences can provide novel insights into using photovoice in a virtual environment and useful considerations around ethics and data collection for researchers who work with socioeconomically disadvantaged groups. Photo-elicited interviews offer an engaging and flexible data collection technique that can highlight issues informing future priorities of healthcare policy., 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: The aim of this study was to investigate the social and environmental factors involved in the food decision-making processes of families living on lower incomes on the Island of Ireland., Design: A qualitative design was employed for this study, using photovoice and creative mapping methods. Parents were requested to take photos and draw maps of their food environments. Interviews were then conducted with parents, using the materials produced by parents as a cue to discuss their food environments, influences and decision-making processes around food choices., Setting: The participants were interviewed online via Microsoft Teams., Participants: The participants were parents or guardians of children between the ages of 2 and 18 who self-defined as 'living on a tight budget'., Results: Twenty-eight participants were recruited and interviewed for this study, including twelve parents in Northern Ireland and sixteen in the Republic of Ireland. The findings were mapped on to Bronfenbrenner's Ecological Systems Theory and showed that multiple, overlapping and intersecting factors at the individual, micro-, meso-, exo-, macro- and chrono-system were implicated in family food choices. Upstream factors in particular, including structural, policy and commercial determinants, appear to be significant drivers of behaviour., Conclusions: While the findings suggest that a complex range of factors are involved in family food choices, it is clear that policy measures and regulations are needed to stave off the impacts of rising social inequality and food poverty. Health promoters should strive to find non-stigmatising interventions to bridge the nutritional divide experienced by lower-income families.

Food poverty and insecurity have become a public health emergency in many high-income countries. News media coverage can shape public and political views towards such issues. This rapid review synthesizes the evidence on how food poverty and insecurity are represented in the news media. Peer-reviewed publications were accessed through three electronic databases, with reference lists of all included studies screened. Primary research studies conducted in high-income countries and published in English since 1995 were included, with no restrictions on study methods. A combination of deductive coding to Entman's framing theory and inductive analysis was used. Ten studies, mostly rated as low quality, were included in the review. Newspapers were the only type of news media examined. The findings showed a largely absent nuanced understanding of food poverty and insecurity, with the problem often defined by food bank use and the consequences mainly focused on physical health. The causes were mostly attributed to structural factors, with the solutions largely focused on charitable food aid. The discourse of recipient (un)deservingness of food aid was evident. Articles often contained views from government officials and charities, with individuals' experiences of food poverty and insecurity largely absent. The findings of this review highlight that a major shift in print media discourse on food poverty and insecurity is required. More balanced and critical news reporting is required to present a more realistic picture of food poverty and insecurity, including its multi-dimensional nature, limitations of food charity and the need for structural solutions to this important issue., (© The Author(s) 2023. Published by Oxford University Press.)

Purpose of Review: To summarize selected late-breaking science on cardiovascular (CV) disease prevention presented at the 2023 European Society of Cardiology (ESC) congress., Recent Findings: The NATURE-PARADOX was a naturally randomized trial that used genetic data from the UK Biobank registry to create "cumulative exposure to low-density lipoprotein-cholesterol (LDL-C)" biomarker and evaluate its association with major CV events regardless of plasma LDL-C levels or age. Safety and efficacy data of inclisiran, a PCSK9-interfering mRNA (PCSK9i) administered subcutaneously twice annually, were presented. Data on two new PCSK9is were presented, recaticimab, an oral drug, and lerodalcibep, a subcutaneous drug with a slightly different architecture than currently available PSCK9is. A phase 1 trial on muvalaplin, an oral lipoprotein (a) inhibitor, was presented. An atherosclerotic CV disease (ASCVD) risk prediction algorithm for the Asian population using SCORE2 data was presented. Long-term follow-up of patients enrolled in the CLEAR outcomes trial showed sustained and more significant ASCVD risk reduction with bempedoic acid in high-risk patients. The late-breaking clinical science at the 2023 congress of the ESC extends the known safety and efficacy data of a PCSK9i with the introduction of new drugs in this class. Using cumulative exposure to LDL-C rather than a single value will help clinicians tailor the LDL-C reduction strategy to individual risk and is an important step towards personalized medicine., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To examine the proportion of people with aphasia (PwA) included and retained in randomised controlled trials (RCTs) of stroke interventions published in the previous 6 years, as well as aphasia-relevant eligibility criteria and inclusion/retention strategies., Data Sources: Comprehensive searching of Embase, PubMed and Medline (Ovid) for the period January 2016 - November 2022., Review Methods: RCTs examining stroke interventions targeting cognition, psychological wellbeing/health-related quality of life (HRQL), multidisciplinary rehabilitation, and self-management were included. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) Randomised Controlled Trial checklist. Descriptive statistics were applied to extracted data, and results were reported narratively., Results: Fifty-seven RCTs were included. These examined self-management (32%), physical (26%) psychological wellbeing/HRQL (18%), cognitive (14%), and multidisciplinary (11%) interventions. Of 7313 participants, 107 (1.5%) had aphasia and were included in three trials. About one-third did not report on aphasia (32%); over one quarter required functional communication (28%); one quarter excluded all aphasia (25%); and 14% excluded severe aphasia. No aphasia-specific inclusion/retention strategies were available., Conclusion: The findings highlight ongoing under-representation. However, due to shortcomings in aphasia reporting, the findings may underestimate actual inclusion rate. Excluding PwA has implications for the external validity, effectiveness, and implementation of stroke research findings. Triallists may require support in aphasia research strategies and methodological reporting.

In this study, the laser-induced graphitization process of sustainable chitosan-based formulations was investigated. In particular, optimal lasing conditions were investigated alongside the effect of borax concentration in the chitosan matrix. In all cases, it was found that the obtained formulations were graphitizable with a CO 2 laser. This process gave rise to the formation of high surface area, porous, and electrically conductive laser-induced graphene (LIG) structures. It was found that borax, as a cross-linker of chitosan, enabled the graphitization process when its content was ≥30 wt % in the chitosan matrix, allowing the formation of an LIG phase with a significant content of graphite-like structures. The graphitization process was investigated by thermogravimetric analysis (TGA), Raman, X-ray photoemission (XPS), and Fourier transform infrared (FTIR) spectroscopies. LIG electrodes obtained from CS/40B formulations displayed a sheet resistance as low as 110 Ω/sq. Electrochemical characterization was performed after a 10 min electrode activation by cycling in 1 M KCl. A heterogeneous electron transfer rate, k 0 , of 4 × 10 -3 cm s -1 was determined, indicating rapid electron transfer rates at the electrode surface. These results show promise for the introduction of a new class of sustainable composites for LIG electrochemical sensing platforms., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Two-dimensional transition metal dichalcogenides (2D-TMDs) have been proposed as novel optoelectronic materials for space applications due to their relatively light weight. MoS 2 has been shown to have excellent semiconducting and photonic properties. Although the strong interaction of ionizing gamma radiation with bulk materials has been demonstrated, understanding its effect on atomically thin materials has scarcely been investigated. Here, we report the effect of gamma irradiation on the structural and electronic properties of a monolayer of MoS 2 . We perform Raman spectroscopy and X-ray photoelectron spectroscopy (XPS) studies of MoS 2 , before and after gamma ray irradiation with varying doses and density functional theory (DFT) calculations. The Raman spectra and XPS results demonstrate that point defects dominate after the gamma irradiation of MoS 2 . DFT calculations elucidate the electronic properties of MoS 2 before and after irradiation. Our work makes several contributions to the field of 2D materials research. First, our study of the electronic density of states and the electronic properties of a MoS 2 monolayer irradiated by gamma rays sheds light on the properties of a MoS 2 monolayer under gamma irradiation. Second, our study confirms that point defects are formed as a result of gamma irradiation. And third, our DFT calculations qualitatively suggest that the conductivity of the MoS 2 monolayer may increase after gamma irradiation due to the creation of additional defect states.

Objectives: In vitro fertilisation (IVF) add-ons are additional procedures offered alongside an IVF cycle with the aim of improving live birth rates. They are controversial because of the paucity of evidence to support their efficacy and safety, alongside the additional financial cost they often pose to patients. Despite this, they are popular. However, there is limited qualitative research regarding their use. The aims of the VALUE Study were to understand the decision-making process surrounding using or recommending add-ons; report sources of information for add-ons; and explore concerns for safety and effectiveness when considering their use., Design: 'VALUE' is a qualitative semistructured interview study using inductive thematic analysis of anonymised transcriptions., Setting: Participants were recruited from a broad geographical spread across the UK and Australia from public and private clinical settings., Participants: Patients (n=25) and health professionals (embryologists (n=25) and clinicians (n=24)) were interviewed. A purposive sampling strategy was undertaken. The sampling framework included people having state-subsidised and private cycles, professionals working in public and private sectors, geographical location and professionals of all grades., Results: Patients often made decisions about add-ons based on hope, minimising considerations of safety, efficacy or cost, whereas professionals sought the best outcomes for their patients and wanted to avoid them wasting their money. The driving forces behind add-on use differed: for patients, a professional opinion was the most influential reason, whereas for professionals, it was seen as patient driven. For both groups, applying the available evidence to individual circumstances was very challenging, especially in the sphere of IVF medicine, where the stakes are high., Conclusions: There is scope to build on the quality of the discourse between patients and professionals. Patients describe valuing their autonomy with add-ons, but for professionals, undertaking informed consent will be critical, no matter where they sit on the spectrum regarding add-ons., Trial Registration: osf.io/vnyb9., Competing Interests: Competing interests: SCA is a consultant gynaecologist and subspecialist in reproductive medicine and surgery. She is an editor for Cochrane Gynaecology and Fertility, and Human Fertility. In the past 12 months, she has been an invited speaker for ESHRE, receiving expenses for travel. She has no financial relationships or affiliations with any commercial companies. EV is an obstetrics and gynaecology registrar; from 2020 to 2022, she was a National Institute for Health and Care Research (NIHR) Academic Clinical Fellow with the University of Bristol. She currently works as a Clinical Fellow in an NHS Reproductive Medicine Unit, at University College London Hospital. She has no financial relationships or affiliations with any commercial companies. SL is a clinical triallist and methodologist, employed by the University of Melbourne. She has a strong interest in randomised controlled trials and systematic reviews and is an editor for the Cochrane Gynaecology and Fertility Group. She has no financial relationships or affiliations with any commercial companies and has received research funding from only government and not-for-profit organisations. LC has no conflicts of interest to declare. CMF is a professor of obstetrics and gynaecology, University of Auckland, New Zealand. She is a fertility specialist, clinical director of Gynaecology and Fertility Plus, Auckland District Health Board, New Zealand and coordinating editor of the Cochrane Gynaecology and Fertility Group. She has no financial relationships with any commercial companies or fertility clinics. She is an invited speaker for ESHRE 2022, receiving expenses for travel. AP is the editor in chief of Human Fertility, trustee of the Progress Educational Trust and chairman of the advisory committee of the UK National External Quality Assurance Schemes in Andrology (all unpaid). In the last 24 months, he has undertaken paid consultancy, speaker fees or contributor fees from Cryos International, Cytoswim, Exseed Health and Merck Serono Limited, but all monies associated with these are paid to the University of Sheffield. MP is a behavioural scientist employed by the University of Melbourne. She is president-elect for the Australian Society for Psychosocial Obstetrics and Gynaecology and is on the editorial board for Journal of Psychosocial Oncology Research and Practice. She is an invited speaker for ESHRE 2022, receiving expenses for travel. She has no financial relationships or affiliations with any commercial companies and has received research funding from only government and not-for-profit organisations. AHB is an NHS consultant in reproductive medicine, honorary chair and clinical lead for Leeds Centre for Reproductive Medicine, Leeds Teaching Hospitals NHS Trust. He is also a consultant at CARE Fertility, Leeds, and chair of the CARE Fertility UK Innovation and Research Board. He is Fellows’ Representative, RCOG Council for Northern, Yorkshire and Humber, a trustee of the British Fertility Society (BFS) and a member of the WHO Guideline Development Group on Infertility. He is a director of Balance Reproductive Health and a member of the advisory board on PCOS and weight reduction, NovoNordisk Pharmaceuticals, for which he has received speaker’s fees for attending meetings. EW is a chartered psychologist (academic) employed by the Universities of Aberdeen and Bath and with an Honorary Research Fellowship at Bath Spa University. She has a strong interest and expertise in qualitative methods as applied to health services research. She has no financial relationships or affiliations with any commercial companies and has received research funding from only government and not-for-profit organisations., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We describe the epidemiology and clinical characteristics of 29 patients with cancer and diarrhea in whom Enteroaggregative Escherichia coli (EAEC) was initially identified by GI BioFire panel multiplex. E. coli strains were successfully isolated from fecal cultures in 14 of 29 patients. Six of the 14 strains were identified as EAEC and 8 belonged to other diverse E. coli groups of unknown pathogenesis. We investigated these strains by their adherence to human intestinal organoids, cytotoxic responses, antibiotic resistance profile, full sequencing of their genomes, and annotation of their functional virulome. Interestingly, we discovered novel and enhanced adherence and aggregative patterns for several diarrheagenic pathotypes that were not previously seen when co-cultured with immortalized cell lines. EAEC isolates displayed exceptional adherence and aggregation to human colonoids compared not only to diverse GI E. coli , but also compared to prototype strains of other diarrheagenic E. coli . Some of the diverse E. coli strains that could not be classified as a conventional pathotype also showed an enhanced aggregative and cytotoxic response. Notably, we found a high carriage rate of antibiotic resistance genes in both EAEC strains and diverse GI E. coli isolates and observed a positive correlation between adherence to colonoids and the number of metal acquisition genes carried in both EAEC and the diverse E. coli strains. This work indicates that E. coli from cancer patients constitute strains of remarkable pathotypic and genomic divergence, including strains of unknown disease etiology with unique virulomes. Future studies will allow for the opportunity to re-define E. coli pathotypes with greater diagnostic accuracy and into more clinically relevant groupings.

As interlocutors in national level discourse with the power to influence public opinion and inform policy, the news media are an important data source in understanding the constitutive roles played by culture and discourse in shaping health experiences and outcomes. This paper reports on a critical discourse analysis of news media coverage of HIV in the Republic of Ireland between 2006 and 2016. This period is significant because of the considerable increase in new HIV diagnoses that occurred in Ireland after the 2008 recession. Analysis of articles ( n  = 103) demonstrated a pattern of dividing practices whereby people living with or affected by HIV were frequently positioned as somatically and morally deficient via discourses of risk and responsibility. Little focus was given over to examination of the structural drivers of HIV, occluding the social context of the epidemic. The findings suggest that media discourses on HIV have the potential to other people living with HIV and generate stigma by invoking a dynamic of blame and shame frequently implicated in the stigma process.

Background IVF add-ons are techniques, medicines or procedures used in addition to standard IVF with the aim of improving the chance of success. The United Kingdom's IVF regulator, ( the Human Fertilisation Embryology Authority (HFEA) developed a traffic light system to categorise add-ons as either green, amber, or red, based on results of randomised controlled trials. Method Qualitative interviews were undertaken to explore understanding and views of the HFEA traffic light system among IVF clinicians, embryologists and IVF patients across Australia and the United Kingdom. Results A total of 73 interviews were conducted. Overall, participants were supportive of the intention of the traffic light system, however many limitations were raised. It was widely recognized that a simple traffic light system necessarily omits information which may be important to understanding the evidence base. In particular, the red category was used in scenarios that patients viewed as having different implications for their decision-making, including 'no evidence' and 'evidence of harm'. Patients were surprised at the absence of any green add-ons and questioned the value of a traffic light system in this context. Many participants considered the website a helpful starting point, but desired more detail, including the contributing studies, results specific to patient demographics (e.g., <35 years and >35 years), and inclusion of more options (e.g. acupuncture). Overall, participants believed the website to be reliable and trustworthy, particularly due to the Government affiliation, and despite some concerns regarding transparency and an overly cautious regulator. Conclusion Participants identified many limitations with the current application of the traffic light system. These could be considered in any future updates to the HFEA website and for others developing similar decision support tools.

Blood and lymphatic vessels are regulators of physiological processes, including oxygenation and fluid transport. Both vessels are ubiquitous throughout the body and are critical for sustaining tissue homeostasis. The complexity of each vessel's processes has limited the understanding of exactly how the vessels maintain their functions. Both vessels have been shown to be involved in the pathogenesis of many diseases, including cancer metastasis, and it is crucial to probe further specific mechanisms involved. In vitro models are developed to better understand blood and lymphatic physiological functions and their mechanisms. In this review, blood and lymphatic in vitro model systems, including 2D and 3D designs made using Transwells, microfluidic devices, organoid cultures, and various other methods, are described. Models studying endothelial cell-extracellular matrix interactions, endothelial barrier properties, transendothelial transport and cell migration, lymph/angiogenesis, vascular inflammation, and endothelial-cancer cell interactions are particularly focused. While the field has made significant progress in modeling and understanding lymphatic and blood vasculature, more models that include coculture of multiple cell types, complex extracellular matrix, and 3D morphologies, particularly for models mimicking disease states, will help further the understanding of the role of blood and lymphatic vasculature in health and disease., (© 2022 The Authors. Advanced Biology published by Wiley-VCH GmbH.)

Adolescents belonging to minority or marginalized groups often experience discrimination, which may negatively affect their mental and physical health. Using the dataset of the 2018 Health Behaviour in School-Aged Children (HBSC) study, we analyzed perceived discrimination based on various grounds in four minority groups of schoolchildren in Ireland: sexual minority youth, youth living with a disability or chronic condition, immigrant youth, and youth belonging to the Traveller community. To minimize the potential confounding effect of psycho-social contextual factors, we used a case-control matching approach, comparing minority groups with their non-minority peers matched by gender, age group, and social class. Minority groups were significantly more likely than their matched non-minority counterparts to report discrimination, not only on the basis of their minority status but also on other grounds. These associations varied in their effect size. We discuss educational and policy implications of the findings for reducing discrimination and structural stigma in school settings.

We conducted a secondary data analysis to evaluate the association between annual foot exams and incident lower extremity amputations (LEA) among older veterans with diabetes during FY2007-FY2014. Older Veterans with at least one primary care provider visit each year (N = 664,162) and at least one foot exam each year (N = 72,892) and the overlap were identified from the 5 years prior to the study period of interest (FY2002-FY2006 (N = 71,122)). After excluding incident LEA related to cancer and trauma, 71,018 veterans (mean age +/- SD, % male) were included in the final cohort, which was followed from FY2007-FY2014 to evaluate the influence of subsequent annual foot exams and incident LEA. Consistent annual foot exams were protective for incident LEA in older veterans with diabetes, adjusted OR was 0.85 (97% CI: 0.74-0.96). Results indicate that adherence to annual foot exam guidelines can reduce incident LEA in older veterans with diabetes.

Lymph nodes (LNs) are highly structured lymphoid organs that compartmentalize B and T cells in the outer cortex and inner paracortex, respectively, and are supported by a collagen-rich reticular network. Tissue material properties like viscoelasticity and diffusion of materials within extracellular spaces and their implications on cellular behavior and therapeutic delivery have been a recent topic of investigation. Here, we developed a nanoparticle system to investigate the rheological properties, including pore size and viscoelasticity, through multiple particle tracking (MPT) combined with LN slice cultures. Dense coatings with polyethylene glycol (PEG) allow nanoparticles to diffuse within the LN extracellular spaces. Despite differences in function in B and T cell zones, we found that extracellular tissue properties and mesh spacing do not change significantly in the cortex and paracortex, though nanoparticle diffusion was slightly reduced in B cell zones. Interestingly, our data suggest that LN pore sizes are smaller than the previously predicted 10-20 μm, with pore sizes ranging from 500 nm-1.5 μm. Our studies also confirm that LNs exhibit viscoelastic properties, with an initial solid-like response followed by stress-relaxation at higher frequencies. Finally, we found that nanoparticle diffusion is dependent on LN location, with nanoparticles in skin draining LNs exhibiting a higher diffusion coefficient and pore size compared to mesenteric LNs. Our data shed new light onto LN interstitial tissue properties, pore size, and define surface chemistry parameters required for nanoparticles to diffuse within LN interstitium. Our studies also provide both a tool for studying LN interstitium and developing design criteria for nanoparticles targeting LN interstitial spaces.

Financial barriers and limited cooking facilities are major obstacles to healthy dietary practices among the homeless population. Homelessness is currently at crisis point and up-to-date evidence from multiple stakeholders is needed to address dietary inequalities. The aim of this study was to understand dietary practices, barriers to healthy eating within homeless services from multiple perspectives. Twelve service users and five healthcare and social service providers participated in semi-structured interviews. Data were analysed thematically. Four themes were identified which included: lack of control over diet and food supply; sources of food for the homeless population; practical barriers to good nutrition; and the impact of diet on emotional and physical wellbeing. Frequent consumption of energy-dense, nutrient-poor foods was reported. Food insecurity resulted in perceived depressive symptoms and stress. Barriers to healthy diet included financial constraints and a lack of access to cooking and storage facilities. Our study highlights low levels of food skills and healthy eating knowledge among service users and service providers. In order to address diet-related health disparities, health promotion initiatives should be targeted at building healthy public policy in relation to diet and nutrition and developing food skills with members of this population and service providers.

We developed a flexible laser scribed graphitic carbon based lactate biosensor fabricated using a low cost 450 nm laser. We demonstrated a facile fabrication method involving electrodeposition of platinum followed by two casting steps for modification with chitosan and lactate oxidase. The biosensor demonstrated chronoamperometric lactate detection within a linear range from 0.2 mM to 3 mM, (R 2  > 0.99), with a limit of detection of 0.11 mM and a sensitivity of 35.8 μA/mM/cm 2 . The biosensor was successful in performing up to 10 consecutive measurements (one after the other) indicating good working stability (RSD <5%). Concerning storage stability, there was no decrease in signal response after 30 days of storage at 4 °C. Additionally, we demonstrate enzymatic lactate detection whilst the flexible polyimide substrates were fixed at a curvature (K) of 0.14 mm -1 . No noticeable change in signal response was observed in comparison to calibrations obtained at a curvature of 0 mm -1 , signifying potential opportunities for sensor attachment or integration with oral-care products such as mouth swabs. Both laser scribed graphitic carbon and Ag/AgCl modified-laser scribed graphitic carbon were successful as reference electrodes for chronoamperometric lactate measurements. Furthermore, using a three-electrode configuration on polyimide, lactate detection in both artificial saliva and sterile human serum samples was achieved for two spiked concentrations (0.5 mM and 1 mM)., (Crown Copyright © 2022. Published by Elsevier B.V. All rights reserved.)

Ultra-sensitive and responsive humidity sensors were fabricated by deposition of graphene oxide (GO) on laser-induced graphene (LIG) electrodes fabricated by a low-cost visible laser scribing tool. The effects of GO layer thickness and electrode geometry were investigated. Sensors comprising 0.33 mg/mL GO drop-deposited on spiral LIG electrodes exhibited high sensitivity up to 1800 pF/% RH at 22 °C, which is higher than previously reported LIG/GO sensors. The high performance was ascribed to the high density of the hydroxyl groups of GO, promoted by post-synthesis sonication treatment, resulting in high water physisorption rates. As a result, the sensors also displayed good stability and short response/recovery times across a wide tested range of 0-97% RH. The fabricated sensors were benchmarked against commercial humidity sensors and displayed comparable performance and stability. Finally, the sensors were integrated with a near-field communication tag to function as a wireless, battery-less humidity sensor platform for easy read-out of environmental humidity values using smartphones.

Background: Sleep problems are reported in up to 50% of adolescents and young adults (AYA) with cancer. Cognitive behavioural therapy for insomnia (CBTi) is considered the gold-standard treatment. In the AYA population, CBTi is associated with improvements in insomnia, daytime sleepiness, fatigue and quality of life. In adults, stepped-care interventions can improve accessibility to CBTi. This study aims to evaluate the acceptability and feasibility of a stepped-care CBTi programme in AYA with cancer., Methods and Analysis: AYA (target N = 80) aged 16-25 with a diagnosis of cancer will be screened using the Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS). When sleep difficulties are identified by the ISI and/or ESS, they will be screened for obstructive sleep apnoea and restless leg syndrome and referred to a sleep service if indicated. The remainder with sleep difficulties will be offered a stepped-care sleep programme including CBT self-management and coaching (first step). Participants will then be rescreened at 5 weeks, and those with ongoing sleep difficulties will be offered individualised CBT (second step). Recruitment and retention rates, adherence to intervention and time taken to deliver screening and intervention will be collected to assess the feasibility of the programme. AYA and clinicians will complete evaluation surveys to assess the acceptability of the AYA Can-Sleep programme., Discussion: We seek to contribute to the evidence base regarding screening and treatment of sleep difficulties in the AYA population by implementing the AYA Can-Sleep programme and determining its feasibility and acceptability as an approach to care in an Adolescent & Young Adult Cancer Service., (© 2022. The Author(s).)

We report a simple, scalable two-step method for direct-write laser fabrication of 3D, porous graphene-like carbon electrodes from polyimide films with integrated contact plugs to underlying metal layers (Au or Ni). Irradiation at high average CO 2 laser power (30 W) and low scan speed (∼18 mm s) -1 leads to formation of 'keyhole' contact plugs through local ablation of polyimide (initial thickness 17 μ m) and graphitization of the plug perimeter wall. Top-surface laser-induced graphene (LIG) electrodes are then formed and connected to the plug by raster patterning at lower laser power (3.7 W) and higher scan speed (200 mm s) -1 . Sheet resistance data (71 ± 15 Ω sq.) -1 indicates formation of high-quality surface LIG, consistent with Raman data which yield sharp first- and second-order peaks. We have also demonstrated that high-quality LIG requires a minimum initial polyimide thickness. Capacitance data measured between surface LIG electrodes and the buried metal film indicate a polyimide layer of thickness ∼7 μ m remaining following laser processing. By contrast, laser graphitization of polyimide of initial thickness ∼8 μ m yielded devices with large sheet resistance (>1 kΩ sq.) -1 . Raman data also indicated significant disorder. Plug contact resistance values were calculated from analysis of transfer line measurement data for single- and multi-plug test structures. Contacts to buried nickel layers yielded lower plug resistances (1-plug: 158 ± 7 Ω , 4-plug: 31 ± 14 Ω) compared to contacts to buried gold (1-plug: 346 ± 37 Ω , 4-plug: 52 ± 3 Ω). Further reductions are expected for multi-plug structures with increased areal density. Proof-of-concept mm-scale LIG electrochemical devices with local contact plugs yielded rapid electron transfer kinetics (rate constant k 0  ∼ 0.017 cm s -1 ), comparable to values measured for exposed Au films ( k 0  ∼0.023 cm s) -1 . Our results highlight the potential for integration of LIG-based sensor electrodes with semiconductor or roll-to-roll manufacturing., (Creative Commons Attribution license.)

States across the country have been experiencing a steady decline in public health nursing workforce, including North Carolina (NC)., Objectives: To better understand retention in the NC Public Health Nurses (PHNs) workforce through an assessment of perceptions of the working environment, stress, intent to stay, and job satisfaction., Design: A cross-sectional online survey using closed and open-ended questions., Sample: The study population comprised of non-supervisory PHNs (n = 672) working at NC local health departments (LHD)., Measurements: Retention problem, working environment, and job satisfaction measures were adapted from the revised Casey-Fink Registered Nurse Retention Survey© (2009) to fit public health settings., Results: Despite high levels of job satisfaction (79.76%, n = 473), 53% of respondents (n = 323) acknowledged a retention problem within their LHD; 35.32% (n = 203) planned to/considered leaving their position in the next 3 years for reasons other than retirement. ANOVAs and Kruskal Wallis Test results showed that those planning to leave had statistically lower scores on perceived working environment and job satisfaction and demonstrated higher negative stress levels., Conclusion: Like other states, NC is experiencing a PHN shortages predicted to worsen in coming years. To retain the current workforce, LHDs need to work to improve PHNs working environment, increase PHNs' pay, and alleviate stressors., (© 2021 Wiley Periodicals LLC.)

This case of acute rupture of a splenic artery aneurysm in a patient 35 weeks pregnant demonstrates the difficulties in diagnosis and importance of multidisciplinary team management for surgical emergencies in pregnancy. A women in her early 30s presented at 35 weeks pregnant with sudden onset of severe epigastric pain and shortness of breath and was found to be tachycardic with a raised lactate. Differentials included a possible vascular event or pulmonary embolism. A CT scan demonstrated free fluid and likely ruptured splenic artery aneurysm. A rapid, thorough preoperative meeting enabled us to integrate multidisciplinary care effectively. She underwent coiling of her splenic artery, which was essential to reduce further intraoperative blood loss, followed by a midline incision for caesarean section of her baby and splenectomy. She had a long stay in the intensive care unit (ITU) and complex postoperative course but was discharged after 2 months to be reunited with her baby who was in good condition., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

The relationship between problem gambling and depression is well documented. However, there are few studies that have explored the mechanisms that may help maintain the association between depression symptoms and problem gambling. This study tests the assumption that gambling for escape and excitement may either mediate or moderate the relationship between depression and problem gambling. To test these propositions, 282 adults who gambled at least once a month were recruited to complete an online survey that assessed depression severity, the gambling outcomes expectancies of escape and excitement and problem gambling. The study did not find evidence for a mediation effect for either escape or excitement, although escape moderated the relationship between depression and problem gambling. In particular, there was not a relationship between depression and problem gambling when there was low endorsement of the escape gambling outcomes expectancies. However, the relationship between depression and problem gambling strengthened when endorsement of gambling as an escape increased. This indicates that individuals with elevated levels of depression symptoms, and who view gambling as a way to moderate mood states, may be at higher risk for problem gambling than those who hold less favourable views towards gambling as a mood modifier. This suggests it may be helpful to consider the gambling expectancies of gamblers experiencing problems when formulating educational and treatment initiatives, especially with those experiencing heightened levels of depressive symptoms., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

BACKGROUND Rural, primary care providers face particular challenges with adapting the delivery of care in the setting of the Coronavirus Disease of 2019 (COVID-19) pandemic. Project ECHO® is a virtual, case-based platform centered on collective learning. As a regional Area Health Education Center (AHEC), we developed two Project ECHO® series aimed at disseminating best practices and creating a community of shared experiences for rural providers. METHODS On March 30, 2020, we launched two Project ECHO® series pertaining to COVID-19: the Primary Care COVID-19 Collaborative series and the Practice Support for COVID-19 Preparedness series. These series each occurred twice weekly, concluding in February 2021, and were free to attend. Topics include COVID-19-specific management as well as strategies for adapting the delivery of care during the pandemic. We assessed engagement per county as well as attendee evaluations. RESULTS In the first month, we hosted 19 sessions with 283 participants from 37 counties in North Carolina. Providers felt the most impactful aspects of the sessions were the changes to their practice and the lateral learning from peers in the region. LIMITATIONS In review of our survey responses, a small percentage of our participants do not appear to have direct patient care roles, so we believe this impacted our survey results particularly in regard to relevance to clinical practice and change to clinical practice. CONCLUSIONS Project ECHO® is an effective platform for quickly disseminating information and creating a sense of community in the midst of the social distancing required during the pandemic., (©2022 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

Many computational pipelines exist for the detection of differentially expressed genes. However, computational pipelines for functional gene detection rarely exist. We developed a new computational pipeline for functional gene identification from transcriptome profiling data. Key features of the pipeline include batch effect correction, clustering optimization by gap statistics, gene ontology analysis of clustered genes, and literature analysis for functional gene discovery. By leveraging this pipeline on RNA-seq datasets from two mouse retinal development studies, we identified 7 candidate genes involved in the formation of the photoreceptor outer segment. The expression of top three candidate genes (Pde8b, Laptm4b, and Nr1h4) in the outer segment of the developing mouse retina were experimentally validated by immunohistochemical analysis. This computational pipeline can accurately predict novel functional gene for a specific biological process, e.g., development of the outer segment and synapses of the photoreceptor cells in the mouse retina. This pipeline can also be useful to discover functional genes for other biological processes and in other organs and tissues., (© 2021. The Author(s).)

Huntington's disease (HD) is an autosomal neurodegenerative disorder caused by extended trinucleotide CAG repetition in the HTT gene. Wild-type huntingtin protein (HTT) is essential, involved in a variety of crucial cellular functions such as vesicle transportation, cell division, transcription regulation, autophagy, and tissue maintenance. The mutant HTT (mHTT) proteins in the body interfere with HTT's normal cellular functions and cause additional detrimental effects. In this review, we discuss multiple approaches targeting DNA and RNA to reduce mHTT expression. These approaches are categorized into non-allele-specific silencing and allele-specific-silencing using Single Nucleotide Polymorphisms (SNPs) and haplogroup analysis. Additionally, this review discusses a potential application of recent CRISPR prime editing technology in targeting HD., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Non-alcoholic fatty liver disease (NAFLD) is reaching epidemic proportions worldwide. Collectively, Latin American countries have some of the highest obesity rates in the world and the fastest-growing prevalence of type 2 diabetes mellitus (T2DM). Since obesity and T2DM are intrinsically linked with NAFLD, epidemiological projections are worrisome. In addition to this adverse epidemiological setting, the region of Latin America faces unique challenges and obstacles to addressing the growing burden of NAFLD. In this article, on the occasion of the International NASH Day on June 10, 2021, we describe the main challenges and opportunities to improve care of people living with NAFLD in Latin America. Among the major challenges to be tackled are: lack of disease awareness, limited educational opportunities for healthcare personnel and general public, health system fragmentation, and lack of effective strategies for the prevention and effective treatment of NAFLD and common comorbidities, namely obesity and T2DM. Wide dissemination of current concepts on NAFLD, and extensive collaboration between scientific societies, governments, non-governmental organizations, pharmaceutical industry, and other stakeholders is urgently needed to advance the NAFLD public health policies agenda that allows us to address this disease with a whole of society approach., (Copyright © 2021. Published by Elsevier España, S.L.U.)

Interleukin-6 (IL-6) is an important immuno-modulating cytokine playing a pivotal role in inflammatory processes in disease induction and progression. As IL-6 serves as an important indicator of disease state, it is of paramount importance to develop low cost, fast and sensitive improved methods of detection. Here we present an electrochemical immunosensor platform based on the use of highly porous graphitic carbon electrodes fabricated by direct laser writing of commercial polyimide tapes and chemically modified with capture IL-6 antibodies. The unique porous and 3D morphology, as well as the high density of edge planes of the graphitic carbon electrodes, resulted in a fast heterogeneous electron transfer (HET) rate, k 0 = 0.13 cm/s. The resulting immunosensor showed a linear response to log of concentration in the working range of 10 to 500 pg/mL, and low limit of detection (LOD) of 5.1 pg/mL IL-6 in phosphate buffer saline. The total test time was approximately 90 min, faster than the time required for ELISA testing. Moreover, the assay did not require additional sample pre-concentration or labelling steps. The immunosensor shelf-life was long, with stable results obtained after 6 weeks of storage at 4 °C, and the selectivity was high, as no response was obtained in the presence of another inflammatory cytokine, Interlukin-4. These results show that laser-fabricated graphitic carbon electrodes can be used as selective and sensitive electrochemical immunosensors and offer a viable option for rapid and low-cost biomarker detection for point-of-care analysis.

Objective: The Action for Health in Diabetes (Look AHEAD) study previously reported that intensive lifestyle intervention (ILI) reduced incident depressive symptoms and improved health-related quality of life (HRQOL) over nearly 10 years of intervention compared with a control group (the diabetes support and education group [DSE]) in participants with type 2 diabetes and overweight or obesity. The present study compared incident depressive symptoms and changes in HRQOL in these groups for an additional 6 years following termination of the ILI in September 2012., Methods: A total of 1,945 ILI participants and 1,900 DSE participants completed at least one of four planned postintervention assessments at which weight, mood (via the Patient Health Questionnaire-9), antidepressant medication use, and HRQOL (via the Medical Outcomes Scale, Short Form-36) were measured., Results: ILI participants and DSE participants lost 3.1 (0.3) and 3.8 (0.3) kg [represented as mean (SE); p = 0.10], respectively, during the 6-year postintervention follow-up. No significant differences were observed between groups during this time in incident mild or greater symptoms of depression, antidepressant medication use, or in changes on the physical component summary or mental component summary scores of the Short Form-36. In both groups, mental component summary scores were higher than physical component summary scores., Conclusions: Prior participation in the ILI, compared with the DSE group, did not appear to improve subsequent mood or HRQOL during 6 years of postintervention follow-up., (© 2021 The Obesity Society.)

Introduction: For couples undergoing assisted reproduction, a plethora of adjuncts are available; these are known as 'add-ons'. Most add-ons are not supported by good quality randomised trial evidence of efficacy, with some proven to be ineffective. However, estimates suggest that over 70% of fertility clinics provide at least one add-on, often at extra cost to the patient. This study has three aims. First, to undertake a survey of in vitro fertilisation (IVF) clinics in the UK to ascertain which add-ons are being offered and at what cost. Second, to undertake qualitative semi-structured interviews of patients, clinicians and embryologists, to explore their opinions and beliefs surrounding add-ons. Third, to review the interpretation of the Human Fertilisation and Embryology Authority traffic light system, to better understand the information required by IVF patients, clinicians and embryologists when making decisions about add-ons., Methods and Analysis: All UK IVF clinics will be contacted by email and invited to complete an online survey. The survey will ask them which add-ons they offer, at what cost per cycle and how information is shared with patients. Semi-structured interviews will be conducted in the UK and Australia with three groups of participants: (i) fertility patients; (ii) clinicians and (iii) embryologists. Participants for the interviews will be recruited via social media channels, website adverts, email and snowball sampling. Up to 20 participants will be recruited for each group in each country. Following an online consent process, interviews will be conducted via video-conferencing software, transcribed verbatim and data subjected to inductive thematic analysis., Ethics and Dissemination: Ethical approval has been granted by the Universities of Sheffield, Bath Spa and Melbourne. Findings will be published in a peer-reviewed journal and disseminated to regulatory bodies in the UK and Australia. A lay summary of findings will be shared via Fertility Network, UK., Competing Interests: Competing interests: SCA, SL, EV, MP, CMF and EW have no competing interests. AP and AHB are trustees of the British Fertility Society (Charity number 1075661) and AP is also a trustee of the Progress Educational Trust (Charity number 1139856)., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Few US studies have examined the usefulness of participatory surveillance during the coronavirus disease 2019 (COVID-19) pandemic for enhancing local health response efforts, particularly in rural settings. We report on the development and implementation of an internet-based COVID-19 participatory surveillance tool in rural Appalachia., Methods: A regional collaboration among public health partners culminated in the design and implementation of the COVID-19 Self-Checker, a local online symptom tracker. The tool collected data on participant demographic characteristics and health history. County residents were then invited to take part in an automated daily electronic follow-up to monitor symptom progression, assess barriers to care and testing, and collect data on COVID-19 test results and symptom resolution., Results: Nearly 6500 county residents visited and 1755 residents completed the COVID-19 Self-Checker from April 30 through June 9, 2020. Of the 579 residents who reported severe or mild COVID-19 symptoms, COVID-19 symptoms were primarily reported among women (n = 408, 70.5%), adults with preexisting health conditions (n = 246, 70.5%), adults aged 18-44 (n = 301, 52.0%), and users who reported not having a health care provider (n = 131, 22.6%). Initial findings showed underrepresentation of some racial/ethnic and non-English-speaking groups., Practical Implications: This low-cost internet-based platform provided a flexible means to collect participatory surveillance data on local changes in COVID-19 symptoms and adapt to guidance. Data from this tool can be used to monitor the efficacy of public health response measures at the local level in rural Appalachia.

Objective: We reevaluated the Action for Health in Diabetes (Look AHEAD) intervention, incorporating diabetes subgroups, to identify whether intensive lifestyle intervention (ILI) is associated with differential risk for cardiovascular disease (CVD) by diabetes subgroup., Research Design and Methods: In the Look AHEAD trial, 5,145 participants, aged 45-76 years, with type 2 diabetes (T2D) and overweight or obesity were randomly assigned to 10 years of ILI or a control condition of diabetes support and education. The ILI focused on weight loss through decreased caloric intake and increased physical activity. To characterize diabetes subgroups, we applied k-means clustering to data on age of diabetes diagnosis, BMI, waist circumference, and glycated hemoglobin. We examined whether relative intervention effects on the trial's prespecified CVD outcomes varied among diabetes subgroups., Results: We characterized four subgroups related to older age at diabetes onset (42% of sample), poor glucose control (14%), severe obesity (24%), and younger age at diabetes onset (20%). We observed interactions (all P < 0.05) between intervention and diabetes subgroups for three separate composite cardiovascular outcomes. Randomization to ILI was associated with increased risk for each cardiovascular outcome only among the poor-glucose-control subgroup (hazard ratio >1.32). Among the three other diabetes subgroups, ILI was not associated with increased risk for CVD., Conclusions: Among overweight and obese adults with T2D, a lifestyle intervention was associated with differential risk for CVD that was dependent on diabetes subgroup. Diabetes subgroups may be important to identify the patients who would achieve benefit and avoid harm from an ILI., (© 2021 by the American Diabetes Association.)

Sun bear populations are fragmented and at risk from habitat loss and exploitation for body parts. These threats are made worse by significant gaps in knowledge of sun bear population genetic diversity, population connectivity, and taxonomically significant management units. Using a complete sun bear mitochondrial genome, we developed a set of mitochondrial markers to assess haplotype variation and the evolutionary history of sun bears from Peninsular (West) Malaysia and Sabah (East Malaysia). Genetic samples from 28 sun bears from Peninsular Malaysia, 36 from Sabah, and 18 from Thailand were amplified with primers targeting a 1800 bp region of the mitochondrial genome including the complete mitochondrial control region and adjacent genes. Sequences were analyzed using phylogenetic methods. We identified 51 mitochondrial haplotypes among 82 sun bears. Phylogenetic and network analyses provided strong support for a deep split between Malaysian sun bears and sun bears in East Thailand and Yunnan province in China. The Malaysian lineage was further subdivided into two clades: Peninsular Malaysian and Malaysian Borneo (Sabah). Sun bears from Thailand occurred in both Sabah and Peninsular Malaysian clades. Our study supports recent findings that sun bears from Sundaland form a distinct clade from those in China and Indochina with Thailand possessing lineages from the three clades. Importantly, we demonstrate a more recent and clear genetic delineation between sun bears from the Malay Peninsula and Sabah indicating historical barriers to gene flow within the Sundaic region., (© The American Genetic Association. 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Outcome 5 of the Irish Better Outcomes, Brighter Futures national youth policy framework ("Connected, respected, and contributing to their world") offers a suitable way to study psychosocial determinants of adolescent health. The present study (1) provides nationally representative data on how 15- to 17-year-olds score on these indicators; (2) compares sexual minority (same- and both-gender attracted youth) with their non-minority peers. We analyzed data from 3354 young people (aged 15.78 ± 0.78 years) participating in the Health Behaviour in School-aged Children (HBSC) study in Ireland. Age and social class were associated with the indicators only to a small extent, but girls were more likely than boys to report discrimination based on gender and age. Frequency of positive answers ranged from 67% (feeling comfortable with friends) to 12% (being involved in volunteer work). Sexual minority youth were more likely to feel discriminated based on sexual orientation, age, and gender. Both-gender attracted youth were less likely than the other groups to report positive outcomes. Same-gender attracted youth were twice as likely as non-minority youth to volunteer. The results indicate the importance of a comprehensive approach to psycho-social factors in youth health, and the need for inclusivity of sexual minority (especially bisexual) youth.

Background: Nivolumab has been associated with immune-related adverse events, including nephritis, with acute interstitial nephritis being the most commonly reported renal manifestation., Case: We describe the first case to our knowledge of minimal change disease with nephrotic syndrome associated with the PD-1 checkpoint inhibitor, Nivolumab. Minimal change disease has been reported with other immune checkpoint inhibitors; however, this is the first reported case with Nivolumab. We report development of nephrotic syndrome with acute kidney injury in a 57-year-old man, 1 month after commencement of Nivolumab for metastatic squamous cell carcinoma of the tongue. Minimal change disease was confirmed by renal biopsy. Management with corticosteroids and cessation of Nivolumab failed to improve kidney function or nephrosis., Conclusion: This case adds to current literature identifying minimal change as an additional complication of immune checkpoint inhibitor-associated acute kidney injury. Given the increasing use of immune checkpoint inhibitors for a range of malignancies, nephrologists, oncologist and generalists should be aware of the spectrum of kidney pathologies associated with their use., (© 2020 Wiley Periodicals LLC.)