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In the face of climate change, women's preconceived vulnerability and virtuousness often deflect focus from gender inequality in decision-making and leadership. Within environmental, political, and social crises, women are capable and proficient leaders who are pivotal to climate change action and are already inspiring social change in innovative ways. This article presents examples of women-led environment movements in the Asia-Pacific that challenge the patriarchal notions that women must be rescued rather than actively participate in their salvation. Historically, strategies have been centered on eco-conscious activism and organized protests. As climate change effects become more evident, engagement has transformed into emergency response and preparedness, with women's groups shepherding and leveraging through healthcare settings and grassroots and community networks. The way forward is to urge meaningful policy actions to support women as effective planetary stewards and campaigners against environmental challenges. This will be achieved through funding mechanisms, gender-inclusive representation mentorships, and pathways that transcend political boundaries.

Background During the course of the COVID-19 pandemic, states were called upon by the World Health Organization to introduce and prioritise the collection of sex-disaggregated data. The collection of sex-disaggregated data on COVID-19 testing, infection rates, hospital admissions, and deaths, when available, has informed our understanding of the biology of the infectious disease. The collection of sex-disaggregated data should also better inform our understanding of the gendered impacts that contribute to risk of exposure to COVID-19. In China, the country with the longest history of fighting the COVID-19 infection, what research was available on the gender-differential impacts of COVID-19 in the first 6 months of the COVID-19 pandemic? Methods In this scoping review, we examine the first 6 months (January–June 2020) of peer-reviewed publications (n = 451) on sex and gender experiences related to COVID-19 in China. We conducted an exhaustive search of published Chinese and English language research papers on COVID-19 in mainland China. We used a COVID-19 Gender Matrix informed by the JPHIEGO gender analysis toolkit to examine and illuminate research into the gendered impacts of COVID-19 within China. Results In China, only a small portion of the COVID-19-related research focused on gender experiences and differences. Near the end of the six-month literature review period, a small number of research items emerged on women healthcare workers, women’s mental health, and pregnant women’s access to care. There was an absence of research on the gendered impact of COVID-19 amongst populations. There was minimal consideration of the economic, social and security factors, including gender stereotypes and expectations, that affected different populations’ experiences of infection, treatment, and lockdown during the period of review. Conclusion At the outset of health emergencies in China, gender research needs to be prioritised during the first stage of an outbreak to assist with evaluation of the most effective public health measures, identifying access to healthcare and social welfare barriers amongst priority communities. Gender stereotypes and gendered differences lead to different patterns of exposure and treatment. The exclusion of this knowledge in real time affects the design of effective prevention and recovery.

Upadacitinib was approved to treat rheumatoid arthritis, psoriasis, ulcerative colitis, ankylosing spondylitis, and atopic dermatitis. This study assessed the adverse events (AEs) associated with upadacitinib by mining data from the US Food and Drug Administration Adverse Event Reporting System (FAERS). Disproportionality analyses, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multi-item gamma Poisson shrinker (MGPS) algorithms, were employed to quantify the signals of upadacitinib-associated AEs. A total of 3,837,420 reports of AEs were collected from the FAERS database, of which 4494 reports were identified with upadacitinib as the “primary suspect (PS)”. Upadacitinib-induced AEs occurrence targeted 27 system organ clases (SOCs). A total of 200 significant disproportionality PTs conforming to the four algorithms were simultaneously retained. Unexpected significant AEs, such as arthralgia, musculoskeletal stiffness, diverticulitis, and cataract might also occur. The median onset time of upadacitinib-associated AEs was 65 days (interquartile range [IQR] 21–182 days), and most of the onsets occurred within the first 1, 2, 3, and 4 months after initiation of upadacitinib. This study found potential new AEs signals and might provide important support for clinical monitoring and risk identification of upadacitinib.

© 2021 Hedley et al. Suicide is a global health problem affecting both normative and clinical populations. Theoretical models that examine mechanisms underlying suicide risk across heterogeneous samples are needed. The present study explored core characteristics associated with autism spectrum disorder (ASD), a sub-population at high risk of suicide, as well as two dimensional cognitive constructs, as potential transdiagnostic predictors of suicidal ideation in a clinically diverse sample. Participants (n = 1851, 62% female) aged 18 to 89 years completed online questionnaires assessing: social communication difficulties; insistence on sameness; cognitive control; and rumination. Forty-three percent of participants reported the presence of at least one neurodevelopmental or neuropsychiatric disorder. One third of the sample reported some suicidal ideation (SI), and 40 percent met the threshold for concern for depression. All hypothesized constructs were associated with SI and depression and, with the exception of rumination, contributed significantly to SI. Participants reporting SI returned significantly higher social communication difficulties and insistence on sameness, and lower levels of cognitive control than those reporting no-SI. The study was limited by the use of a cross-sectional sample assessed with self-report measures. All diagnoses were selfreported and the study was additionally limited by the use of a single item indicator of suicidal ideation. These findings support a role for constructs associated with the ASD phenotype and associated broad cognitive domains as potential risk factors underlying suicidal ideation in a large clinically diverse sample. Our findings suggest directions for future longitudinal research studies, along with specific targets for suicide prevention and clinical practice.

Background Chemoattractant is critical to recruitment of osteoclast precursors and stimulates tumor bone metastasis. However, the role of chemoattractant in bone metastasis of colorectal cancer (CRC) is still unclear. Methods Histochemistry analysis and TRAP staining were utilized to detect the bone resorption and activation of osteoclasts (OCs) after administration of CCL7 neutralizing antibody or CCR1 siRNA. qRT-PCR analysis and ELISA assay were performed to detect the mRNA level and protein level of chemoattractant. BrdU assay and Tunel assay were used to detect the proliferation and apoptosis of osteoclast precursors (OCPs). The migration of OCPs was detected by Transwell assay. Western blots assay was performed to examine the protein levels of pathways regulating the expression of CCL7 or CCR1. Results OCPs-derived CCL7 was significantly upregulated in bone marrow after bone metastasis of CRC. Blockage of CCL7 efficiently prevented bone resorption. Administration of CCL7 promoted the migration of OCPs. Lactate promoted the expression of CCL7 through JNK pathway. In addition, CCR1 was the most important receptor of CCL7. Conclusion Our study indicates the essential role of CCL7-CCR1 signaling for recruitment of OCPs in early bone metastasis of CRC. Targeting CCL7 or CCR1 could restore the bone volume, which could be a potential therapeutical target.

Summary: Purpose: This study investigated the ability of liquid nitrogen cryo-insults to induce early-stage osteonecrosis of the femoral head (ONFH) in small tail Han sheep. Methods: 16 animals were subjected to unilateral cryo-insult using cryogen equipment with a cryo-insult probe, followed 1, 3, and 6 months later by X-ray, CT scanning, micro-CT scanning, and histological evaluation. Results: X-ray evaluation of operative femoral heads (Op-FHs) at each time point showed low density areas under the cartilage surface that paralleled sclerosis belts, and CT scans showed sclerosis and cyst areas in Op-FHs. Micro-CT analysis showed that the ratio of bone to total volume and mean trabecular thickness of regions of interest (ROIs) were lower in Op-FHs than in normal femoral heads (No-FHs) at each time point (n = 4, p < 0.05). Histological evaluation at 1 month showed that necrotic changes were dominant as evidenced by moderate empty lacunae, decreases in the number of hematopoietic cells, and moderate increases in the number of fibroblasts. At 3 and 6 months, fractured trabeculae, fibroblasts, and new blood capillaries were increased, indicating an absorption and repair process. Bone volume fraction of ROIs of Op-FHs was lower than in No-FHs at each time point (n = 4, p < 0.05) in histological evaluation. At 6 months, the maximum load of No-FHs was higher than Op-FHs (n = 4, p < 0.05). Conclusion: These findings indicate that early-stage ONFH can be induced in small tail Han sheep using cryogenic equipment. The translational potential of this article: This animal model may be helpful in developing new treatment modalities for human ONFH.

Social media can be both a source of information and misinformation during health emergencies. During the COVID-19 pandemic, social media became a ubiquitous tool for people to communicate and represents a rich source of data researchers can use to analyse users’ experiences, knowledge and sentiments. Research on social media posts during COVID-19 has identified, to date, the perpetuity of traditional gendered norms and experiences. Yet these studies are mostly based on Western social media platforms. Little is known about gendered experiences of lockdown communicated on non-Western social media platforms. Using data from Weibo, China’s leading social media platform, we examine gendered user patterns and sentiment during the first wave of the pandemic between 1 January 2020 and 1 July 2020. We find that Weibo posts by self-identified women and men conformed with some gendered norms identified on other social media platforms during the COVID-19 pandemic (posting patterns and keyword usage) but not all (sentiment). This insight may be important for targeted public health messaging on social media during future health emergencies.

Considerable scientific evidence showing climate change will amplify disasters and cause adverse health impacts. If not mitigated, climate change will push health systems beyond their limits and capacity. The projected trend of increasing climaterelated disasters will intensify existing health risks arising from more frequent and severe extreme weather events like floods, bushfires, poor air and water quality, and emerging and re-emerging infectious diseases. This incidents place enormous demands on the future of the healthcare sector, especially on hospitals. To prepare for and deal with the immense challenges ahead, hospitals need to incorporate climate change adaptation (CCA)1 strategies into planning for disaster risk reduction (DRR)2. It is, thus, timely to investigate the feasibility of and pathways to future-poof hospitals against disasters in a changing climate. Hospitals are no stranger to climate change as an issue. They are at the forefront of addressing the health impacts of disasters, treating the illnesses and injuries caused by them, and upholding critical response roles during and after disasters. This role will continue to expand as hospitals struggle to cope with the additional demands of climate change-related disasters. Many hospitals have in place their own emergency response procedures, but little information is available in terms of the extent of how they have incorporated CCA measures into their risk management plans. While hospitals are affected by climate change there is also the reality that they are in part responsible for accelerating climate change. Studies estimate that the healthcare sector is responsible for approximately 4.4% of anthropogenic greenhouse gas emissions. Therefore, it is important therefore for healthcare to start shifting to renewable and reliable energy sources and adopt environmentally responsible waste management practices. The problem remains to facilitate this; it would require leadership commitment, and full participation of other healthcare sector stakeholders. The organisation Health Promoting Hospitals Network (HPH), with members worldwide, promotes an integrative, eco-friendly partnership approach to improving hospital practices. The HPH is well-suited to leading the way to integrate DRR and CCA to future-proof hospitals, making it an ideal partner for this research. Among its network members, Taiwan, with its extensive HPH network and supportive government policies, was chosen for this study. Therefore, this study aims to examine opportunities and strategies for developing HPH’s work in Taiwan ensuring that hospitals are geared towards being future-proof against disasters brought about by climate change. The research began with an extensive critical literature review and then applied quantitative and qualitative methods to conduct a case study on Taiwan’s Health Promoting Hospitals. The study adopted the participatory action research (AR) approach, commonly used in health promoting settings, because it enables participants to develop strategies and actions for change and improve knowledge, strategies, and actions in the process. Overall, the study found that the AR process enabled HPH participants to lead the climate movement in the healthcare sector in Taiwan. This has led Taiwan’s health promoting hospitals to transform towards a sustainable future. Using the AR process, key challenges to effectively implement DRR and CCA efforts were identified, and it was determined that these issues could be addressed through standards that regulate hospitals. Therefore, the researchers and partners created and advocated for a new climate action standard under Taiwan’s Healthy Hospitals 2.0 Accreditation Program. As the study was being conducted, the whole world was affected by the COVID-19 and soon after a pandemic was announced. This led to the AR to modify its priorities in response to emergency needs. The result is the co-design of eco-friendly measures that could ensure healthcare workers’ protection and safety and to make healthcare reduce hazardous waste given that the pandemic has produced many unintentional health care wastes in the process of battling the virus. The research and its findings first synthesise the literature on the rationale for linking CCA and DRR in the hospital sector to inform health authorities and hospital decisionmakers on the need to incorporate these into future action plans. Second, it identifies useful indicators and strategies to guide climate action for building future-proof hospitals, especially in Taiwan. Third, it addresses organisational changes and ways HPH networks could advocate for and facilitate these changes, including strategies to leverage that hospital accreditation scheme to enhance adherence. Finally, the research adds to the evidence that HPHs can use participatory AR to deal with complex issues to better prepare for the future. This is not only timely but has practical implications for other settings-based health promotion movements such as Healthy Cities, Workplaces, and Health-Promoting Schools to help them integrate CCA and DRR into their future action plans in the pursuit of sustainable development.

Additional file 1. Keywords and search syntax.

Purpose There is a significant knowledge gap regarding the lives of adults on the autism spectrum. Some literature suggests significant health and mental health inequalities for autistic adults, yet there is a lack of comprehensive longitudinal studies exploring risk factors. Further, most research does not include the perspective of autistic adults in its conduct or design. Here, we describe the baseline characteristics and inclusive research approach of a nationwide longitudinal study. Participants The Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Adults with Autism (ALSAA) is a questionnaire-based longitudinal study of autistic adults (25+ years old) with follow-up at 2-year intervals. Autistic advisors were involved in each stage of research apart from data analysis. Three questionnaires were developed: self-report, informant report (ie, proxy report) and carers (ie, carer experiences and characteristics). Findings to date An inclusive research protocol was developed and agreed with autistic advisors. Baseline data were collected from 295 autistic adults (M=41.8 years, SD=12.0) including 42 informant responses, 146 comparison participants and 102 carers. The majority of autistic participants (90%) had been diagnosed in adulthood (M=35.3 years, SD=15.1). When compared with controls, autistic adults scored higher on self-report measures of current depression and anxiety. Participant comments informed ongoing data gathering. Participants commented on questionnaire length, difficulty with literal interpretation of forced response items and expressed gratitude for research in this area. Future plans A large comprehensive dataset relating to autistic adults and their carers has been gathered, creating a good platform for longitudinal follow-up repeat surveys and collaborative research. Several outputs are in development, with focus on health service barriers and usage, caregivers, impact of diagnosis in adulthood, further scale validations, longitudinal analyses of loneliness, suicidal ideation, mental illness risk factors and other areas. Baseline data confirm poorer mental health of autistic adults. The ALSAA demonstrates a working approach to inclusive research.

Additional file 1. Figure S1: Early OCPs were the primary cellular source of CCL7 in CRC-microenvironment. (A) Schematic of sorting dominant cellular types from bone marrow at 10 days post injection of MC-38 cells. (B) Representative image of flow cytometry strategy of isolating neutrophils and eosinophils. (C) Representative image of flow cytometry strategy of isolating T cells. (D) Representative image of flow cytometry strategy of isolating BMMSCs. (E) qRT-PCR analysis detected mRNA level of CCL7 in neutrophils, eosinophils, T cells, BMMSCs and early OCPs isolated from 10 days post injection of MC-38 compared to that in MC-38 cells. n=3, each sample was pooled from 5-8 mice. **p

Emotion dysregulation is a common issue experienced by individuals with autism spectrum disorder (ASD) and has been associated with a wide range of negative mental and physical health outcomes. This commentary highlights the role emotion dysregulation plays in ASD by first considering the literature on emotion regulation (ER) in the general population and then summarizing the ER research in ASD. Based on the evaluation of previous research findings, we conclude that individuals with ASD have more ER difficulties and consistently self-report or demonstrate a less adaptive pattern of ER strategy use. In addition, the higher prevalence of internalizing and externalizing issues seen in ASD are associated with the greater habitual use of some ER strategies and less habitual use of others. Conceptual and methodological limitations are discussed, including the use of coping measures and single-method approaches, and ASD gender distribution. We propose a set of new directions for investigating ER in ASD, incorporating knowledge from other literatures on the role of flexibility in healthy adaptation, overlaps between flexibility and executive function deficits, the adaptive value of up-regulation of positive emotions, and the importance of emotional selfawareness. Increasing our capacity for identifying the mechanisms underlying co-morbid affective disorders can ultimately inform the design of effective interventions to maximize the wellbeing of individuals with ASD.

Gender norms, roles and relations differentially affect women, men, and non-binary individuals' vulnerability to disease. Outbreak response measures also have immediate and long-term gendered effects. However, gender-based analysis of outbreaks and responses is limited by lack of data and little integration of feminist analysis within global health scholarship. Recognising these barriers, this paper applies a gender matrix methodology, grounded in feminist political economy approaches, to evaluate the gendered effects of the COVID-19 pandemic and response in four case studies: China, Hong Kong, Canada, and the UK. Through a rapid scoping of documentation of the gendered effects of the outbreak, it applies the matrix framework to analyse findings, identifying common themes across the case studies: financial discrimination, crisis in care, and unequal risks and secondary effects. Results point to transnational structural conditions which put women on the front lines of the pandemic at work and at home while denying them health, economic and personal security - effects that are exacerbated where racism and other forms of discrimination intersect with gender inequities. Given that women and people living at the intersections of multiple inequities are made additionally vulnerable by pandemic responses, intersectional feminist responses should be prioritised at the beginning of any crises.

Background: Endometrial cancer (EC) is one of the most common malignant tumor in the female reproductive system. The incidence of lymph node metastasis (LNM) is only about 10% in clinically suspected early-stage EC patients. Discovering prognostic model and effective biomarkers for early diagnosis is important to reduce the mortality rate. Methods: We downloaded the RNA-sequencing data and clinical information from the TCGA database. Gene ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were used to analyze the differentially expressed genes (DEGs). A least absolute shrinkage and selection operator (LASSO) regression was conducted to identify the characteristic dimension decrease and distinguish prognosis-related LNM related genes signature. Subsequently, a novel prognosis-related nomogram to predict overall survival (OS). A survival analysis was carried out to explore the individual prognostic significance of the risk model and key gene was validated in vitro. Results: In total, 89 LRGs were identified. Based on the LASSO Cox regression, 11 genes were selected for the development of a risk evaluation model. The Kaplan–Meier curve indicated that patients in the low-risk group had considerably better OS (P = 3.583e−08). The area under the curve (AUC) of this model was 0.718 at 5 years of OS. Then, we developed an OS-associated nomogram that included the risk score and clinicopathological features. The concordance index of the nomogram was 0.769. The survival verification performed in three subgroups from the nomogram demonstrated the validity of the model. The AUC of the nomogram was 0.787 at 5 years OS. Proliferation and metastasis of HMGB3 were explored in EC cell line. Finally, we revealed that the most frequently mutated genes in the low-risk and high-risk groups are PTEN and TP53, respectively. Conclusions: Our results suggest that LNM plays an important role in the prognosis, and HMGB3 was potential as a biomarker for EC patients. By detecting the mutation of the risk signature, clinicians can accurately treat patients with targeted therapy, thereby improving their survival rate.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors represent newly developed oral antidiabetic drugs that are practiced for type 2 diabetes mellitus management and may decrease the risk of the first hospitalization in heart failure. The activity of SGLT2 inhibitors is not related to glucose, and the effectiveness and safety of SGLT2 inhibitors in individuals with chronic heart failure (CHF) remain unclear. We systematically retrieved PubMed, Cochrane Library, Embase, NCKI, VIP, Wanfang Data, and ClinicalTrials.gov records to identify eligible trials. The primary endpoints were cardiovascular death/hospitalization for heart failure (CV death/HHF), cardiovascular death, and hospitalization for heart failure. Secondary endpoints included hypoglycemia, volume depletion, urinary tract infection, left ventricular ejection fraction (LVEF), and NT-proBNP. Nine randomized controlled clinical trials were included. Dapagliflozin was reported to significantly decrease CV death/HHF (relative risk (RR): 0.75; 95% confidence interval (CI): 0.68–0.84), CV death (RR: 0.80; 95% CI: 0.68–0.93), and HHF (RR: 0.72; 95% CI: 0.63–0.83). There was no effect on hypoglycemia (RR: 0.69; 95% CI: 0.34–1.40), volume depletion (RR: 1.17; 95% CI: 0.97–1.41), urinary tract infection (RR: 0.82; 95% CI: 0.43–1.57), LVEF (WMD: 0.53; 95% CI: −4.04–5.09), or NT-proBNP (SMD: −0.66; 95% CI: −1.42–0.10). The risk of CV death/HHF, CV death, and HHF was lower among patients receiving dapagliflozin than patients receiving placebo.

As COVID-19 cases increase, the global supply of Personal Protective Equipment (PPE) is becoming insufficient, particularly for medical masks and respirators followed closely by gowns and googles. The World Health Organization (WHO) released in February 2020 an interim guidance [1] on the rational use of PPE for coronavirus disease 2019 (COVID-19). The guidance state that to minimize the need for PPE, WHO recommends the “use of physical barriers to reduce exposure to the COVID-19 virus such as glass or plastic windows.”

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Introduction Health and climate change are inexorably linked through the exacerbation of health risks and the contribution of the health sector to greenhouse gas emissions. Climate action in healthcare settings is critical to reduce risks and impacts of climate change through the smarter use of energy, minimising waste and enhancing disaster preparedness. Globally, hospital climate action is growing; however, the potential for further progress and impacts remains. The literature on this topic lacks synthesis, and this poses challenges for hospital leadership in tracking the impact of climate action. This scoping review will summarise the current knowledge about hospital climate action and existing tools to measure progress in this area., Methods and analysis This scoping review will be conducted applying the six-stage protocol proposed by Arksey and O'Malley. The study includes literature of how hospitals have addressed climate change (mitigation and adaptation) since the Kyoto Protocol was signed in 1997. All identified studies indexed in Medline, Scopus, Embase and CINAHL will be examined. The search strategy will also include Google Scholar to capture relevant grey literature. Quantitative and thematic analysis will be used to evaluate and categorise the study results.

In recent years, Indonesia has experienced rapid increases in severe climate-related disasters have dramatically impacted populations unevenly; the poor and the vulnerable populations are most affected, and adaptive measures are urgently needed to protect and mitigate the impact on their health. However, very little is known about the existing measures addressing climate-related disasters and health impacts among vulnerable groups. WHO established a Health Emergency and Disaster Risk Management framework to urge governments and relevant actors to systematically collect evidence to develop science-based feasible adaptive strategies for priority groups. This study used scoping review methods to identify the action areas of Health-EDRM in policy documents in Indonesia, its content, and any potential gaps that require further study. The results from the documents’ review were then reported and discussed at a national stakeholder consultation meeting. This study has identified several achievements, lessons learned, and challenges from strategies and policies for health adaptation in facing climate-related disasters in Indonesia. This study also proposed strategies and recommendations to support mobilizing and accelerating health adaptation actions towards climate-related disasters in Indonesia.

As a first line medicine for malaria treatment, artesunate (ART) also shows antitumor potential. However, little is known about the effect of ART on the cancer cell epithelial-mesenchymal transition (EMT). In this study, we found that ART inhibited cell growth in SK-HEP1 and SM7721 hepatocellular carcinoma cell lines. A microarray was used to identify differentially expressed protein-coding RNAs (pcRNA) and long noncoding RNAs (lncRNA) between SK-HEP1 cells with and without ART treatment. A differentially expressed lncRNA-RP11, the most related to the EMT of liver cancer cells-RP11 was identified by abioinformatics method Overexpressing and silencing assays were used to verify the role of RP11 in cancer cell EMT. The levels of RP11- and EMT-related genes in liver cancer samples from 75 patients were detected by using qualitative polymerase chain reaction or immunohistochemistry. We identified 1334 pcRNAs and 1670 lncRNA with differential expression induced by ART. ART inhibits EMT, proliferation, migration, invasion, and adhesion of liver cancer cells. RP11 depresses the inhibitory effect of ART on cancer cell EMT. The level of RP11 is associated with cancer cell EMT and metastasis and survival rate of the patient. These data suggest that RP11-linking ART and cancer cell EMT are important for ART-inhibited metastasis of liver cancer.

Climate-related disasters are increasing across the globe, but their adverse health impacts are unevenly distributed. The people most severely affected tend to be from socio-economically disadvantaged, vulnerable populations, who have high exposure to risk conditions and insufficient adaptive capacity. Despite the increasing health impacts of climate change and disaster risks felt in Asian countries such as China, Indonesia and Vietnam, there are few attempts to access and translate literature and evidence on climate-related disasters and adaptation activities from non-English speaking countries. Conducted by a multi-country project team, this review aims to better understand the current literature and to study gaps in these three countries through an extensive search of literature, in English, Chinese, Indonesian and Vietnamese. Through a systematic review process a total of 298 studies out of 10,139 were included in this study. Key findings confirm that all three countries have experienced increasing climate-related disasters with their associated health impacts, and that adaptation strategies are urgently needed to reduce the risk and vulnerability of the most affected populations. Future studies should consider conducting vulnerability assessments to inform translational research on developing effective adaptation strategies. Authors commented that a common challenge they found was the shortterm nature of disaster response mechanisms, and the lack of long-term investment and policy support for capacity building and multi-sectoral collaborative research that address the needs of populations vulnerable to climate-related disasters. Thus, to better prepare for future disasters, it is vital that governments and international agencies prioritize funding policies to fill this gap.

Background/aims: The pathogenesis of intrahepatic cholestasis of pregnancy (ICP) is poorly understood. Objective: This study aimed to explore the possible effect of HDAC3 (histone deacetylase) on cytokines IL-18, IL-12 and TNF-α in ICP. Methods: Serum levels of cytokines IL-18, IL-12 and TNF-α, bile acids and hepatic function parameters were measured. The expression of HDAC3 in the placenta was determined by immunohistochemistry (IHC), western blotting and RT-PCR. Results: IL-18, IL-12 and TNF-α serum levels were significantly higher in the severe ICP group than in the mild ICP group and the control group, and the difference between the mild ICP group and control group was not significant. HDAC3 protein expression was identified in the nucleus of the placental trophoblast by IHC. HDAC3 mRNA and protein expression were significantly lower in the ICP groups (mild ICP and severe ICP groups) than in the control groups, and no significant difference was found between the mild ICP and severe ICP groups. Conclusions: The low expression of HDAC3 and overexpession of inflammatory cytokines (IL-18, IL-12 and TNF-α) in ICP may be involved in liver cell apoptosis. We suspect that HDAC3 may play an important role in the pathophysiology of ICP.

Background The Western Ontario Rotator Cuff Index (WORC) is a scale designed to evaluate the impact of rotator cuff (RC) disorders on patients’ general quality of life. Our study aims to adapt the WORC for Chinese patients and to assess its reliability, validity, and responsiveness in Chinese patients with RC disorders. Methods First, we developed the Chinese version of the WORC (C-WORC) in a five-step procedure of translation and cross-cultural adaptation. Next, the recruiting patients finished all three rounds of scales of the C-WORC, the Medical Outcomes Study Short-Form 36 (SF-36), and the Oxford Shoulder score (OSS). Then we calculated Cronbach’s alpha, the intra-class correlation coefficient (ICC), Pearson’s or Spearman’s correlation coefficient ( r or r s ), the effect size (ES), and the standardized response mean (SRM) to evaluate the reliability, validity and responsiveness of the C-WORC, respectively. Results Overall, 124 patients with RC disorders successfully completed the first two rounds of the scales, and 108 patients completed the last round of the scales. Good or excellent internal consistency (Cronbach’s alpha = 0.872–0.954) was found in the overall scale and subscales of C-WORC, as well as good or excellent test-retest reliability (ICC = 0.828–0.961). Moderate or good correlations ( r/r s = 0.472–0.787) were obtained between the physical subscales of the C-WORC and the OSS and the physical subscales of SF-36; the results were also obtained for the emotions subscale of the C-WORC and the mental subscales of SF-36 ( r/r s = 0.520–0.713), which, adequately illustrated that good validity was included in the C-WORC. In addition, good responsiveness was also observed in the overall scale and subscales of the C-WORC (ES = 1.57–2.27, SRM = 1.52–2.28). Conclusions The C-WORC scale is reliable, valid and responsible for the evaluation of Chinese-speaking patients with RC disorders and would be an effective instrument.

To the Editor: Because a healthy and efficient medical workforce is key to containing the present coronavirus disease 2019 pandemic, the protection of health care workers is paramount.1,2 According to the interim guidance for the pandemic from the World Health Organization,3 health care workers must don personal protective equipment (PPE) when testing a patient with a high suspicion of having pneumonia. Such PPE must include an N95 respirator, a pair of goggles or a face shield, a gown, and a pair of gloves.4 However, this set of PPE cannot cover all surfaces of the body. Thus, to minimize the risk of exposure to the pathogen, and to conserve PPE, we constructed a building-integrated sampling station. Designed by Tseng Yu-Chi and Tseng Kai-Chen, this station has a sealed acrylic window serving as a physical barrier separating the interior (where the physician is) from the exterior (where the patient is), and a pair of sealed rubber gloves affixed to the station for the physician to perform

Introduction: Nepal was hit by two devastating earthquakes in 2015 that disrupted its socio-economic system and shattered many lives, resulting in increased mental health issues during the post-earthquake phase. Disasters can have severe mental health impacts on the affected population, making it necessary to enhance resilience within communities and to help them to adapt well in the face of adversities. From these earthquakes, this study looks to identify measures needed to develop community mental resilience for disaster preparedness in Nepal. Method: We conducted this research using the qualitative case study method and thematic analysis (TA). Result: Several activities were carried out by organizations to support the psycho-social aspects of communities, but were challenged by existing barriers. After considering the present context, this study presents five recommendations for mental resilience and also suggests the utilization of existing resources, such as faith-based organizations and teachers in the communities. Despite the considerable impact, communities demonstrate their own resilience, to some extent, through the culture of sharing and helping each other. Conclusions: A firm commitment is required from the government to enhance resilience by mainstreaming mental health in all areas of disaster management and planning.

Part of the Autism CRC Study of Australian School Leavers with Autism. Poster presented in 2015.

Effect of initial martensite and tempered carbide characteristics on mechanical properties of 3Cr2MnNiMo mold steel were investigated. The results indicated that the initial martensite microstructure can be effectively adjusted by changing the quenching temperature. With the increase of quenching temperature from 760 °C to 1010 °C, the initial microstructure gradually changed from acicular ferrite + plate martensite + M7C3 carbides to lath martensite, and the grain size increased monotonically. The coarsening of the initial martensite led to the increase of tempered carbide size, and the morphology of tempered carbide gradually changed from spherical to long strip-shaped. The large-size and long strip-shaped carbides promoted the formation of micro-voids during the tensile deformation and significantly decreased the elongation. In addition, with the coarsening of the martensite microstructure, both the decrease of high-angle grain boundaries (HAGB) density and the appearance of long strip-shaped tempered carbides significantly reduced the impact absorbed energy. The fracture mechanism transformed from ductile fracture caused by micro-voids coalescence to intergranular cleavage fracture. Moreover, when the initial microstructure completely transformed into lath martensite, the yield and tensile strength remained approximately unchanged. The precipitation strengthening compensated the adverse effect of martensite coarsening.

Background Context Polymethylmethacrylate (PMMA) is widely used for pedicle screw augmentation in osteoporosis. Intriguingly, there have been no biomechanical comparisons of the stability of pedicle screws augmented with different volumes of PMMA or studies of the relationship between screw stability and volume of PMMA, especially in different degrees of osteoporosis. Purpose The purposes of the study reported here were to compare screw stability by different volumes of PMMA augmentation, to analyze the relationship between screw stability and PMMA volume, and to make a preliminary determination of the optimum volume of PMMA augmentation for different degrees of osteoporosis. Study Design This study is a biomechanical comparison of pedicle screws augmented with various volumes of PMMA in cadaveric lumbar vertebrae. Methods Thirty-six pedicles from 18 osteoporotic lumbar vertebrae were randomly divided into groups A0 through A5, and 36 pedicles from 18 severely osteoporotic lumbar vertebrae were randomly divided into groups B0 through B5. A different volume of PMMA was injected into each one of groups A0 through A5 (0, 0.5, 1.0, 1.5, 2.0, and 2.5 mL, respectively) and into each one of groups B0 through B5 (0, 1.0, 1.5, 2.0, 2.5, and 3.0 mL, respectively), and then pedicle screws were inserted in all vertebrae. After complete solidification of the PMMA, we examined pedicle X-rays, performed axial pullout tests, and determined the maximum axial pullout strength (F max ) for all samples. Results No PMMA was found around the screws in groups A0 and B0. In groups A1 to A5 and B1 to B5, screws were wrapped by gradually increasing amounts of PMMA. There was no PMMA leakage or screw malpositioning in any samples. The F max in groups A1 through A5 increased by 32.40%, 64.42%, 116.02%, 174.07%, and 207.42%, respectively, compared with that in group A0. There were no significant differences in F max between groups A0 and A1, A1 and A2, A2 and A3, A3 and A4, and A4 and A5 (p>.05), but there were significant differences in F max between any other two groups (p max in groups B1 through B5 increased by 23.48%, 48.40%, 106.60%, 134.73%, and 210.04%, respectively, compared with that in group B0. There were no significant differences in F max between groups B0 and B1, B0 and B2, B1 and B2, B2 and B3, B3 and B4 (p>.05), but there were significant differences in F max between any other two groups (p max and volume of PMMA in both osteoporotic and severely osteoporotic lumbar vertebrae (p Conclusions Polymethylmethacrylate can significantly enhance stability of pedicle screws in both osteoporotic and severely osteoporotic lumbar vertebrae. There is a significant positive correlation between screw stability and volume of PMMA. Within a certain range, nevertheless, increasing the volume of PMMA does not significantly improve screw stability. We suggest that 1.5 and 3 mL, respectively, are the volumes of injected PMMA that will optimize pedicle screw stability in osteoporotic and severely osteoporotic lumbar vertebrae.

In this study, calcium sulfate (CS) was injected through pedicle into the osteoporotic vertebral body in vivo in sheep, and micro-computed tomography analysis, histologic observation, and biomechanical test were performed.To investigate the improvement on microstructure and biomechanical performance of lumbar vertebrae augmented with CS in osteoporotic sheep.The present treatments for osteoporosis relies on systemic medications intended to increase the bone mineral density (BMD). Although effective, these time-consuming medications provide little protection from fracture in the "early period" after initiation of therapy. In this regard, the strategy of local treatment is to target specific areas of the skeletal system that are prone to osteoporotic fractures. However, there is little or no research focused on local treatment of osteoporotic vertebrae with CS.Eight female sheep were induced to osteoporosis with bilateral ovariectomy and methylprednisolone administration for 12 months. After successful establishment of an osteoporotic model, lumbar vertebrae (L1-L4) in every sheep were randomly divided into 2 groups: CS group and control group (2 vertebrae in each group in every sheep). CS was injected into the vertebral body transpedicularly in the CS group and no treatments were performed in the control group. Three months later, all sheep were killed and all L1-L4 vertebrae were harvested. Thereafter, microstructure and biomechanical performance of the cancellous bone of the vertebral body were assessed through micro-computed tomography analysis, histologic observation, and biomechanical test, respectively.After a 12-month induction with ovariectomy and methylprednisolone administration, the mean BMD of the sheep lumbar vertebrae significantly decreased (25%) compared with the value before induction, which demonstrated successful establishment of osteoporosis. Three months after injection of CS, CS was completely degraded without any remains in bone tissue and the quality of bone tissue (amount and density of the bone tissue) in the CS group was significantly higher than that in the control group. The ultimate load, stiffness, and energy absorption in the CS group were all significantly higher than those in the control group.The preliminary data suggest that local injection of CS can significantly improve the amount, density, and biomechanical performance of the bone trabeculae in osteoporotic vertebra. The local injection of CS could also be used as a new method to improve the physical microstructure and augment the mechanical properties in "high-risk" vertebral bodies, decreasing the potential fracture risk of patients with osteoporosis. The strict inclusion and exclusion criteria should be performed before treatment.

There is no ideal implant for mechanical strut on early-stage osteonecrosis of the femoral head (ONFH) after core decompression. In this study, a biogenic trabecular porous titanium rod with lamellar configuration was designed and fabricated using selective laser melting technique. Early-stage ONFH of sheep induced by cryo-insult were dealt with core decompression combined with rod insertion (Rod group) and core decompression alone (CD group) after X-ray evaluation was used to assess the necrotic region one months after cryo-intervention. Bone integration and ingrowth of the two groups were investigated and compared. Early-stage ONFH intervened with the rod gained better bone ingrowth than CD 3 and 6 months after the intervention, as evidenced by radiographic, micro-CT and histological evaluation. X-ray images showed compact integration between rods and peripheral bone, evidenced by no radiolucent lines encircling the rods at 3 and 6 months. Micro-CT and histological images showed that the new bone had grown into the centre of rods along the metal at 3 months, whereas the new bone grew mainly at the periphery of the decompressive channel. Micro-CT analysis show that the ratios of bone volume to total volume (BV/TV) of volume of interest (VOI) in Rod group was 890.0% and 438.1% higher than CD group at 3 (0.198 ± 0.0094 VS 0.020 ± 0.0058, p 0.05, n = 3) and 6 (0.226 ± 0.0166 VS 0.042 ± 0.0061, p 0.05, n = 3) months respectively. Histological analysis showed that the BV/TV of VOI in Rod group was 881.0% and 413.3% higher than CD group at 3 (0.206 ± 0.0102 VS 0.021 ± 0.0061, p 0.05, n = 3) and 6 (0.231 ± 0.0156 VS 0.045 ± 0.0059, p 0.05, n = 3) months respectively. The mechanical tests revealed that the maximum load of Rod group was 57.6% larger than CD group at 6 months (4505.25 ± 443.86 N VS 2858.25 ± 512.91 N, p 0.05, n = 3). These favourable short-term results can provide insight on treatment of early-stage ONFH.

This study aimed to compare the sirtuin 2 (SIRT2) expression between tumor tissue and adjacent tissue, and to investigate the association of tumor SIRT2 expression with clinical characteristics and survival profiles in cervical cancer patients. One hundred ninety-one cervical cancer patients were reviewed in this retrospective study. All patients underwent surgical resection and had well-preserved tumor tissue and adjacent tissue, which were obtained for SIRT2 expression detection by immunohistochemistry (IHC). Clinical parameters were obtained. Disease free survival (DFS) and overall survival (OS) were calculated. Both SIRT2 expression by IHC score (P 3) (P

Lay_Abstract, AUT774558_Lay_Abstract for Emotion regulation in autism: Reappraisal and suppression interactions by Ru Ying Cai, Amanda L Richdale, Cheryl Dissanayake, Julian Trollor and Mirko Uljarević in Autism

The phase transformation behaviors during continuous cooling of low-carbon boron steels with different vanadium contents were studied by means of dilatometric measurement and microstructure observation. The bainite transformation behavior is not noticeably altered when the vanadium content is 0.042 and 0.086 wt%, and these steels exhibit full bainitic microstructure even at a cooling rate of 5 °C/s. When vanadium content is increased to 0.18 wt%, ferrite is still present in the microstructure even at a cooling rate of 40 °C/s. Vickers hardness of the steels with 0.042 and 0.086 wt% V is remarkably higher than that of the steel with 0.18 wt% V at a cooling rate higher than 10 °C/s, and the difference is increased with the increase in cooling rate. Moreover, the amount of coarse vanadium precipitates formed in austenite is increased with the increase in vanadium content. The optimum content of vanadium to obtain bainitic microstructure is 0.086 wt% in this experimental low-carbon boron steels.

The buckling behavior of monolayer graphene sheets with simple-supported, clamped-free and clamped-clamped boundary conditions is investigated by the atomic-scale finite method (AFEM). The initial static equilibrium state of monolayer graphene sheet is obtained in the simulation as a waved configuration which is close to the real graphene observed in experiments. With the increase of compressive displacement, the force displays three stages: linear increasing, nonlinear increasing and decreasing slowly after a sudden drop. Different from the prediction by classical theory, the critical buckling loads of graphene sheets with different boundary conditions are similar, which is attributed to the initial waved configuration of the monolayer graphene sheets.

Vapor instant release and superheated liquid flash evaporation in foods are the two main factors in steam-puffing. The condensed water produced by saturated steam is absorbed by the food material, thereby increasing moisture content. A model, which incorporated moisture content, radius, mechanical properties of un-puffed materials, properties of saturated steam, was generated. Spherical carrots (diameter: 10±1 mm) were used. The results revealed that the puffing power model can be used to predict the relationship between puffing ratio (R2 >0.95) and moisture content (20–32%), and the relationship between puffing ratio (R2 >0.99) and saturated steam temperature (390–430 K). Sufficient moisture content was the basis for producing superheated liquid for puffing; superheated steam at high temperatures was necessary for the formation of superheated liquid and high vapor pressure values in food materials.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by lack of insulin and high glucose levels. T2DM can cause bone loss and fracture, thus leading to diabetic osteoporosis. Promoting osteogenic differentiation of osteoblasts may effectively treat diabetic osteoporosis. We previously reported that Sirtuin 1 (Sirt1), a NAD+-dependent deacetylase, promotes osteogenic differentiation through downregulation of peroxisome proliferator-activated receptor (PPAR) γ. We also found that miR-132 regulates osteogenic differentiation by downregulating Sirt1 in a PPARβ/δ-dependent manner. The ligand-activated transcription factor, PPARα, is another isotype of the peroxisome proliferator-activated receptor family that helps maintain bone homeostasis and promot bone formation. Whether the regulatory role of PPARα in osteogenic differentiation is mediated via Sirt1 remains unclear. In the present study, we aimed to determine this role and the underlying mechanism by using high glucose (HG) and free fatty acids (FFA) to mimic T2DM in MC3T3-E1 cells. The results showed that HG-FFA significantly inhibited expression of PPARα, Sirt1 and osteogenic differentiation, but these effects were markedly reversed by PPARα overexpression. Moreover, siSirt1 attenuated the positive effects of PPARα on osteogenic differentiation, suggesting that PPARα promotes osteogenic differentiation in a Sirt1-dependent manner. Luciferase activity assay confirmed interactions between PPARα and Sirt1. These findings indicate that PPARα promotes osteogenic differentiation via the Sirt1-dependent signaling pathway.

Supplementary Material, AUT687697_Lay_Abstract for Transition to work: Perspectives from the autism spectrum by Darren Hedley, Ru Cai, Mirko Uljarevic, Mathilda Wilmot, Jennifer R Spoor, Amanda Richdale and Cheryl Dissanayake in Autism

STUDY DESIGN Expansive pedicle screw (EPS) and polymethylmethacrylate-augmented pedicle screw (PMMA-PS) were inserted in sheep vertebrae in vitro and were evaluated by performing biomechanical tests, radiographic examinations and histological observations. OBJECTIVE The objective of the study was to compare the biomechanical and interfacial performances of EPS and PMMA-PS in sheep lumbar vertebrae in vitro. SUMMARY OF BACKGROUND DATA It is a great challenge for orthopedic surgeons performing transpedicular fixation in the osteoporotic spine. It was reported that either the EPS or PMMA-PS could increase the screw stability. However, there are no studies comparing the 2 kinds of screws especially in primary spinal instrumentation. METHODS A total of 60 sheep lumbar vertebrae were randomly divided into 3 groups. A pilot hole was made in advance in all samples using the same method. Thereafter, the conventional pedicle screw (CPS) was inserted directly into the pilot hole in the CPS group; the hole in PMMA-PS group was first filled with polymethylmethacrylate (PMMA; 1.0 mL) and then inserted with CPS; and the EPS was inserted directly into the vertebrae in EPS group. After a period of 24 hours, biomechanical tests were performed to evaluate screw stability, and x-ray examination, micro-computerized tomography analysis, and histologic observation were performed to evaluate the interface between screw and bone. RESULTS Compared with the stability of CPS, those of EPS and PMMA-PS were significantly enhanced. However, no significant differences were detected between the stabilities of EPS and PMMA-PS. The PMMA surrounding the screw blocked direct contact between bone and screw and formed a "screw-PMMA-bone" interface in the PMMA-PS group. There was a "screw-bone" interface in both CPS and EPS groups. Nevertheless, the expanded anterior part of EPS formed a claw-like structure pressing the surrounding bone trabeculae, which made the local bone tissue more compacted and denser than that in the CPS group. CONCLUSIONS EPS can enhance the screw stability as markedly as the traditional PMMA-PS in primary surgery, and EPS can form a better immediate interface between screw and bone compared with PMMA-PS. EPS also can effectively avoid thermal injury, leakage, and compression caused by PMMA. A great feasibility was proved in this study to perform comparisons between the 2 kinds of pedicle screws in osteoporotic sheep vertebrae in vivo in the further research. In conclusion, we propose that EPS has a great application potential in augmentation of screw stability in the clinic.

Nowadays, surgical robot has been the research hot spot of the interdisciplinary which includes medical science and robotics field. Surgical robot not only can complete complicated and repetitive work in the radiation and other environment as the substitute of doctor, but also expand doctors capacity of perception and operation, enhancing the operation precision and safety. This paper is based on a three freedom parallel manipulator and considers the characteristics of minimally invasive spinal surgery to design a guiding robot. In this article , the theoretical analysis about kinematics and dynamics is done and the analytic equation is established. The solution to the equation is derived by MATLAB toolboxes. The physical prototype is made based on the solution, the properties of physical prototype are measured and the feasibility of the design is verified.

Motivated by the small lattice mismatch between ferrite and vanadium nitride (VN), we describe here the welding thermal cycle simulation that provides high toughness in the ICRCG HAZ of low carbon V–N steel. This unique behavior is attributed to the formation of ultra-fine grained ferrite along prior austenite grain boundaries generated by the first pass welding thermal cycle with high misorientation boundaries, where V(C, N) precipitates provide potential nucleation sites for ferrite, leading to extraordinary refinement of martensite/austenite (M/A) constituent. Nitrogen stimulates the precipitation behavior of V(C, N). The nucleation of high density of V(C, N) precipitates consumes carbon-content in the austenite, leading to decrease in the carbon-content in the M/A constituent, with consequent decrease in hardness. The increase in toughness is explained in terms of Griffith's crack propagation theory.

Controlled rolling followed by two-stage continuous cooling was carried out in-house to study the microstructure and mechanical properties of a low carbon microalloyed steel plate of medium thickness gauge. The objective of the study was to develop a process of obtaining excellent mechanical properties (strength, toughness, and ductility) in a microalloyed steel. The process is industrially viable because it does not require high degree of cooling and large reduction during thermo-mechanical processing. The study demonstrates that it is possible to obtain yield strength, tensile strength, elongation, and percentage reduction in area 585 MPa, 680 MPa, 29.5%, and 55%, respectively, with total deformation reduction of 50% and small first stage cooling rate. The total impact energy at −20 °C was 140 J. The microstructure consists of polygonal ferrite and acicular ferrite. The strain-induced 20–30 nm precipitates act as nucleation sites for acicular ferrite. The acicular ferrite contributes to high strength and good toughness, while polygonal ferrite provides excellent elongation.

For the purpose of obtaining the appropriate heat input in the simulated weld CGHAZ of the hot-rolled V–N microalloyed high strength S-lean steel, the microstructural evolution, hardness, and toughness subjected to four different heat inputs were investigated. The results indicate that the hardness decreases with increase in the heat input, while the toughness first increases and then decreases. Moderate heat input is optimum, and the microstructure is fine polygonal ferrite, granular bainite, and acicular ferrite with dispersive nano-scale V(C,N) precipitates. The hardness is well-matched with that of the base metal. Moreover, the occurrence of energy dissipating micromechanisms (ductile dimples, tear ridges) contributes to the maximum total impact energy. The detrimental effect of the free N atoms on the toughness can be partly remedied by optimizing the microstructural type, fraction, morphologies, and crystallographic characteristics. The potency of V(C,N) precipitates on intragranular ferrite nucleation without MnS assistance under different heat inputs was discussed.

Controlled rolling followed by accelerated cooling was carried out in-house to study the microstructure and mechanical properties of a low carbon dual-phase steel. The objective of the study described here was to explore the effect of cooling schedule, such as air cooling temperature and coiling temperature, on the final microstructure and mechanical properties of dual-phase steels. Furthermore, the precipitation behavior and yield ratio are discussed. The study demonstrates that it is possible to obtain tensile strength and elongation of 780 MPa and 22 pct, respectively, at the two cooling schedules investigated. The microstructure consists of 90 pct ferrite and 10 pct martensite when subjected to moderate air cooling and low temperature coiling, such that the yield ratio is a low 0.69. The microstructure consists of 75 pct ferrite and 25 pct granular bainite with a high yield ratio of 0.84 when the steel is directly cooled to the coiling temperature. Compared to the conventional dual-phase steels, the high yield strength is attributed to precipitation hardening induced by nanoscale TiC particles and solid solution strengthening by high Si content. The interphase precipitates form at a suitable ledge mobility, and the row spacing changes with the rate of ferrite transformation. There are different orientations of the rows in the same grain because of the different growth directions of the ferrite grain boundaries, and the interface of the two colonies is devoid of precipitates because of the competitive mechanisms of the two orientations.