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This article explores the integration of shared responsibility and zero trust architecture models to enhance the cybersecurity of Industrial Internet of Things (IIoT) systems. It examines the foundational principles and challenges of each model, highlighting their philosophical contradictions and practical applications. By defining key elements and providing illustrative examples, the article identifies common ground and proposes a hybrid approach to secure IIoT deployments. The findings emphasize the importance of collaboration, standardization, and robust security practices to achieve a resilient and secure IIoT environment.

Bleeding is common in patients with haematological malignancies undergoing intensive therapy. We aimed to assess the effect of tranexamic acid on preventing bleeding and the need for platelet transfusions.

ABSTRACTObjectivesInpatient mental health beds for people with dementia are a limited resource. Practitioners need an understanding of this population to provide high-quality care and design services. This review examines the characteristics, care, and outcomes of people with dementia admitted to inpatient mental health services.MethodsSystematic searches of key databases were undertaken up to November 2021. Findings were grouped into categories and then synthesized into a narrative review.ResultsThe review identified 36 international papers, the majority of which were retrospective audits. The literature describes significant psychiatric and medical comorbidity and significant risk of change in residence and death associated with admission.ConclusionsWe found a limited literature describing the characteristics, care, and outcomes of people with dementia in inpatient mental health services. The lack of research is striking given the complexity and vulnerability of this client group. More research is needed to describe the needs of this group, current and best practice to optimize care.Clinical ImplicationsProfessionals working in inpatient mental health services need to be aware of the evidence base available, consider how they evaluate patient outcomes, review their staffing and skills mix, and seek the views of patients and relatives in improving services.

The seedcorn maggot, Delia platura(Meigen), is a pest affecting many crops, including corn. The early spring emergence of adults and belowground seed damage by maggots leave no room for rescue treatments during the short growing season in New York State. Degree-day (DD) models play a crucial role in predicting insect emergence and adult peak activity and are essential for effective pest management. The current D. platuraDD model was launched on the Network for Environment and Weather Applications (NEWA) in 2022, using existing scientific literature from other North American regions. The NEWA model predicted adult D. platurafirst emergence at an average of 471 (39°F) DD in 2022. To gain an accurate and precise understanding of D. platuraadult spring emergence and activity, we used interpolated temperature data to calculate the DD for each specific location where adults were captured in the field. DD calculations were performed using the average method, setting a biofix on January 1st and a base temperature of 39°F. In 2023, overwintering adults emerged at an average of 68 DD, and in 2022, adult activity was registered at an average of 282 DD. Accurately predicting the emergence of D. platuracould contribute to informing integrated pest management strategies that incorporate timing and cultural practices over chemical solutions to protect crops and the environment.

There is an increasing urgency to implement large-scale ecosystem restoration to mitigate the biodiversity and climate crises. These efforts must be scaled up to counteract the widespread degradation of the world’s forests, although restoration costs can often limit their application. Thus, there is a pressing need to identify cost-effective approaches that catalyze landscape-scale ecological recovery. Here, we highlight seven assisted restoration innovations with demonstrated local-scale results that, once upscaled, hold promise to rapidly regenerate forests. We comprehensively assessed how each approach facilitated forest, woodland, and/or mangrove recovery across 143 studies. Our results reveal techniques with a marked ability to catalyze vegetation recovery compared to “business-as-usual” approaches. However, the context-dependent cost-benefit ratio and feasibility of applying particular approaches requires careful consideration. Our assessment emphasizes that we already have many of the tools necessary to drive the terrestrial restoration movement forward. It is time to implement and assess their efficacy at scale.

Soils support a vast amount of carbon (C) that is vulnerable to climatic and anthropogenic global change stressors (for example, drought and human-induced nitrogen deposition). However, the simultaneous effects of an increasing number of global change stressors on soil C storage and persistence across ecosystems are virtually unknown. Here, using 1,880 surface soil samples from 68 countries across all continents, we show that increases in the number of global change stressors simultaneously exceeding medium–high levels of stress (that is, relative to their maximum levels observed in nature) are negatively and significantly correlated with soil C stocks and mineral association across global biomes. Soil C is particularly vulnerable in low-productivity ecosystems (for example, deserts), which are subjected to a greater number of global change stressors exceeding medium–high levels of stress simultaneously. Taken together, our work indicates that the number of global change stressors is a crucial factor for soil C storage and persistence worldwide.

The use of stemless shoulder arthroplasty for osteoarthritis has grown substantially over the past decades. The goal of this study is to evaluate the clinical and radiological outcomes of the Lima SMR stemless anatomic and reverse total shoulder arthroplasty.

A Quaternary sequence of subfossil terrestrial molluscs from tropical Kenya is described and discussed. It preserves a remarkably complete fauna of the Indian Ocean coastal forest from the surroundings of Panga ya Saidi cave, a site featuring repeated human occupation extending back at least 78, 000 years. Mollusc diversity, composition, and abundance are very similar to extant faunas of the coastal forest. They vary relatively little over the period studied (chiefly a 50,000-year sequence from MIS 5 to the start of MIS 2) apart from a short-lived decrease in the dominance of “forest-only” species around 45,800 BP. The fauna of the most recently preserved layers (MIS 1) is likewise similar. Most of the 72 snail (and slug) species found are still extant at the coast, including some narrow-range endemics, but 8 species are now more western in their known distribution. The native African status of Kaliella barrakporensis and 2 other snail species with Asian type localities are confirmed, as is the previously disputed occurrence of native Helicoidea at the coast. Two new subfossil species were identified and are described as Maizania meteor sp. n. (Maizaniidae) and Juventigulella saidii sp. n. (Streptaxidae). No major habitat or faunistic shifts are observed, confirming previous evidence for long-term ecological continuity at the site. The data are the first of their kind from coastal East Africa and provide a new independent proxy of the environmental context to the archaeological sequence, as well as a reference point for future studies of terrestrial molluscs in the region.

Purpose: This paper aims to challenge the fashion of ubiquitous artificial intelligence (AI) and the effects which it will have upon society. In doing so it argues that the effects of AI will be minimal but important. Design/methodology/approach: This argument is based upon the Socratic method and explores the Utilitarian background in which AI is based while drawing upon classical literature and other examples to illustrate the argument. Findings: The findings are encompassed in the argument and show that we need to be more open and careful when considering AI and its effects. We also need to be more realistic when considering potential benefits. Practical implications: This argument has significant implications for the adoption of AI. Social implications: The social implications are equally profound and will impact upon our application of AI solutions to current problems and upon humanity more generally. Originality/value: This is the first paper which relates AI to human successes.

Advances in optical imaging and fluorescent biosensors enable study of the spatiotemporal and long-term neural dynamics in the brain of awake animals. However, methodological difficulties and fibrosis limit similar advances in the spinal cord. Here, to overcome these obstacles, we combined in vivo application of fluoropolymer membranes that inhibit fibrosis, a redesigned implantable spinal imaging chamber and improved motion correction methods that together permit imaging of the spinal cord in awake behaving mice, for months to over a year. We demonstrated a robust ability to monitor axons, identified a spinal cord somatotopic map, performed months-long imaging in freely moving mice, conducted Ca2+imaging of neural dynamics in behaving mice responding to pain-provoking stimuli and observed persistent microglial changes after nerve injury. The ability to couple in vivo imaging and behavior at the spinal cord level will drive insights not previously possible at a key location for somatosensory transmission to the brain.

Forest restoration is fundamental to overcoming biodiversity crises and climate change. In tropical forests, animals can improve forest recovery as they disperse >70% of tree species. However, representing animals in restoration and climate change policies remains challenging because a quantitative assessment of their contribution to forest and carbon recovery is lacking. Here we used individual-based models to assess frugivore-mediated seed rain in open areas along a fragmentation gradient. Movements of large birds were limited in landscapes with <40% forest cover, although small birds continued to disperse seeds. Large birds disperse seeds of late-successional species with higher carbon storage potential. Their restricted movement therefore reduced potential biomass in future forests by 38%. Maintaining forest cover >40% is essential to optimizing animals’ contribution to restoration success. Active restoration (for example, planting trees) is required in more fragmented landscapes to achieve carbon and biodiversity targets.

Compelling evidence has shown that wetland methane emissions are more temperature dependent than carbon dioxide emissions across diverse hydrologic conditions. However, the availability of carbon substrates, which ultimately determines microbial carbon metabolism, has not been adequately accounted for. By combining a global database and a continental-scale experimental study, we showed that differences in the temperature dependence of global wetland methane and carbon dioxide emissions (EM/C) were dependent on soil carbon-to-nitrogen stoichiometry. This can be explained mainly by the positive relationship between soil organic matter decomposability and EM/C. Our study indicates that only 23% of global wetlands will decrease methane relative to carbon dioxide emissions under future warming scenarios when soil organic matter decomposability is considered. Our findings highlight the importance of incorporating soil organic matter biodegradability into model predictions of wetland carbon–climate feedback.

Aim: Lower limb injury rates have increased dramatically in line with the rise in female athletes participating in team sports where larger training demands are required for higher performing athletes, increasing exposure to injury. One modifiable and intrinsic risk factor associated with lower limb injuries is muscle strength, measured through single joint machine isokinetic dynamometry (MID) and handheld dynamometry (HHD). Purpose: The purpose of this review was to explore which protocols have been used for MID and HHD lower limb muscular strength assessments, highlighting the test–retest reliability, for the female team sport athlete population. Methods: A review of the literature was conducted using Medline, PubMed, Scopus, SPORTDiscus and Web of Science databases. Of the 26,032 articles identified, 107 were included for analysis. Results: Seated knee flexion/extension was the most common test performed with a similar protocol while hip and ankle joint muscle group tests were performed across two to four positions. Test–retest reliability was poor to excellent for hip and knee tests and only reported in four studies (intraclass correlation coefficients = 0.25–0.98). Conclusions: The same protocol was followed primarily for MID knee flexion/extension (73 studies). However, differences were observed for MID and HHD hip and ankle joint protocols resulting in variable data that could not support dynamometry protocol recommendations for this population. Research exploring the reliability and validity of protocols including measurement equipment may improve the worth of existing data and assessment protocols to support injury and performance strategies in the future.

Background: The aim of this study was to pool multiple data sets to build a patient-centric, data-informed, natural history model (NHM) for Duchenne muscular dystrophy (DMD) to estimate disease trajectory across patient lifetime under current standard of care in future economic evaluations. The study was conducted as part of Project HERCULES, a multi-stakeholder collaboration to develop tools to support health technology assessments of new treatments for DMD. Methods: Health states were informed by a review of NHMs for DMD and input from clinicians, patients and caregivers, and defined using common outcomes in clinical trials and real-world practice. The primary source informing the NHM was the Critical Path Institute Duchenne Regulatory Science Consortium (D-RSC) database. This was supplemented with expert input obtained via an elicitation exercise, and a systematic literature review and meta-analysis of mortality data. Results: The NHM includes ambulatory, transfer and non-ambulatory phases, which capture loss of ambulation, ability to weight bear and upper body and respiratory function, respectively. The NHM estimates patients spend approximately 9.5 years in ambulatory states, 1.5 years in the transfer state and the remainder of their lives in non-ambulatory states. Median predicted survival is 34.8 years (95% CI 34.1–35.8). Conclusion: The model includes a detailed disease pathway for DMD, including the clinically and economically important transfer state. The NHM may be used to estimate the current trajectory of DMD in economic evaluations of new treatments, facilitating inclusion of a lifetime time horizon, and will help identify areas for further research.

The latitudinal diversity gradient (LDG) dominates global patterns of diversity1,2, but the factors that underlie the LDG remain elusive. Here we use a unique global dataset3to show that vascular plants on oceanic islands exhibit a weakened LDG and explore potential mechanisms for this effect. Our results show that traditional physical drivers of island biogeography4—namely area and isolation—contribute to the difference between island and mainland diversity at a given latitude (that is, the island species deficit), as smaller and more distant islands experience reduced colonization. However, plant species with mutualists are underrepresented on islands, and we find that this plant mutualism filter explains more variation in the island species deficit than abiotic factors. In particular, plant species that require animal pollinators or microbial mutualists such as arbuscular mycorrhizal fungi contribute disproportionately to the island species deficit near the Equator, with contributions decreasing with distance from the Equator. Plant mutualist filters on species richness are particularly strong at low absolute latitudes where mainland richness is highest, weakening the LDG of oceanic islands. These results provide empirical evidence that mutualisms, habitat heterogeneity and dispersal are key to the maintenance of high tropical plant diversity and mediate the biogeographic patterns of plant diversity on Earth.

To monitor for drug-related cardiac arrhythmias, psychiatrists regularly perform and interpret 12-lead (12L) and, increasingly often, six-lead (6L) electrocardiograms (ECGs). It is not known how training on this complex skill is updated or how well psychiatrists can interpret relevant arrhythmias on either device.We conducted an online survey and ECG interpretation test of cardiac rhythms relevant to psychiatrists.A total of 183 prescribers took part; 75% did not regularly update their ECG interpretation skills, and only 22% felt confident in interpreting ECGs. Most participants were able to recognise normal ECGs. For both 6L and 12L ECGs, the majority of participants were able to recognise abnormal ECGs, but fewer than 50% were able to correctly identify relevant arrhythmias (complete heart block and long QTc). A small number prescribed in the presence of potentially fatal arrhythmias. These findings suggest a need for mandatory ECG interpretation training to improve safe prescribing practice.

Understanding what controls global leaf type variation in trees is crucial for comprehending their role in terrestrial ecosystems, including carbon, water and nutrient dynamics. Yet our understanding of the factors influencing forest leaf types remains incomplete, leaving us uncertain about the global proportions of needle-leaved, broadleaved, evergreen and deciduous trees. To address these gaps, we conducted a global, ground-sourced assessment of forest leaf-type variation by integrating forest inventory data with comprehensive leaf form (broadleaf vs needle-leaf) and habit (evergreen vs deciduous) records. We found that global variation in leaf habit is primarily driven by isothermality and soil characteristics, while leaf form is predominantly driven by temperature. Given these relationships, we estimate that 38% of global tree individuals are needle-leaved evergreen, 29% are broadleaved evergreen, 27% are broadleaved deciduous and 5% are needle-leaved deciduous. The aboveground biomass distribution among these tree types is approximately 21% (126.4 Gt), 54% (335.7 Gt), 22% (136.2 Gt) and 3% (18.7 Gt), respectively. We further project that, depending on future emissions pathways, 17–34% of forested areas will experience climate conditions by the end of the century that currently support a different forest type, highlighting the intensification of climatic stress on existing forests. By quantifying the distribution of tree leaf types and their corresponding biomass, and identifying regions where climate change will exert greatest pressure on current leaf types, our results can help improve predictions of future terrestrial ecosystem functioning and carbon cycling.

(Abstracted from JAMA2023;330(7):603–614)Preterm birth is a focus of many studies and interventions but remains the leading cause of global neonatal morbidity and mortality. One particular risk that is elevated in preterm infants is cerebral palsy, which affects movement and/or posture, causing health problems and high health care costs for children and their families.

The optimal strategy for diagnosis and antithrombotic treatment of patients with antiphospholipid syndrome (APS)–associated acute ischemic stroke (AIS), transient ischemic attack (TIA), or other brain ischemic injury is poorly defined.

A participatory action research (PAR) study using co-operative inquiry methods was employed to examine the topic ‘spirituality and childbirth’. Co-operative inquiry (CI) reclaims the right of co-researchers to create knowledge from their own lived experience, an approach that works ‘with’ rather than ‘on’ people, valuing individual contributions. Traditionally, CI has been organised synchronously in the same physical location. However, with current events and need for greater global collaboration for divergent/convergent perspectives, an ‘asynchronous’ CI is important to consider. To date, the authors are not aware of any published/unpublished asynchronous co-operative inquiry research projects. This article describes how our inquiry group worked across global regions and time zones meeting online, via emails and discussion boards, and gathered data in an online repository. The outcomes of this inquiry are published elsewhere, here we discuss the novel methods used to support emergence of a modified CI. We offer insight into how our cycles of reflection and action matured and were possible and enhanced through virtual inquiry methods. While technology posed limitations, working asynchronously across time and space enabled rich and complex conversations. An asynchronous modified CI method allows a depth of inquiry to be achieved whilst retaining the purpose of CI.

It is testament to the advances of modern medicine that we have a population with more older people than ever before. While we are increasingly adept at managing their physical comorbidities, we have made relatively little progress in addressing the psychological impact of ageing. In this article we consider the prevalence and complex aetiology of depression in older people who often have to deal with profound loss, while simultaneously managing multiple comorbidities. We consider the challenges of diagnosing depression faced by healthcare professionals including access to resources and training, and what differentiates depression from socially appropriate low mood. Finally, we discuss treatment options and the difficulties that clinicians face when they have only limited resources and skills available, but a desire to help. We consider the role for antidepressants, and when not to prescribe, before addressing the challenges of providing talking therapies and social interventions.

Cancer pain has traditionally been managed with opioids, adjuvant medications, and interventions including injections, neural blockade, and intrathecal pump (ITP). Spinal cord stimulation (SCS), although increasingly used for conditions such as failed back surgery syndrome and complex regional pain syndrome, is not currently recommended for cancer pain. However, patients with cancer-related pain have demonstrated benefit with SCS. We sought to better characterize these patients and the benefit of SCS in exceptional cases of refractory pain secondary to progression of disease or evolving treatment-related complications.

Purpose: Venous thromboembolism (VTE) is a common complication of critical illness. Sex- or gender-based analyses are rarely conducted and their effect on outcomes is unknown. We assessed for an effect modification of thromboprophylaxis (dalteparin or unfractionated heparin [UFH]) by sex on thrombotic (deep venous thrombosis [DVT], pulmonary embolism [PE], VTE) and mortality outcomes in a secondary analysis of the Prophylaxis for Thromboembolism in Critical Care Trial (PROTECT). Methods: We conducted unadjusted analyses using Cox proportional hazards analysis, stratified by centre and admission diagnostic category, including sex, treatment, and an interaction term. Additionally, we performed adjusted analyses and assessed the credibility of our findings. Results: Critically ill female (n= 1,614) and male (n= 2,113) participants experienced similar rates of DVT, proximal DVT, PE, any VTE, ICU death, and hospital death. In unadjusted analyses, we did not find significant differences in treatment effect favouring males (vsfemales) treated with dalteparin (vsUFH) for proximal leg DVT, any DVT, or any PE, but found a statistically significant effect (moderate certainty) favouring dalteparin in males for any VTE (males: hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52 to 0.96 vsfemales: HR, 1.16; 95% CI, 0.81 to 1.68; P= 0.04). This effect remained after adjustment for baseline characteristics (males: HR, 0.70; 95% CI, 0.52 to 0.96 vsfemales: HR, 1.17; 95% CI, 0.81 to 1.68; P= 0.04) and weight (males: HR, 0.70; 95% CI, 0.52 to 0.96 vsfemales: HR, 1.20; 95% CI, 0.83 to 1.73; P= 0.03). We did not identify a significant effect modification by sex on mortality. Conclusions: We found an effect modification by sex of thromboprophylaxis on VTE in critically ill patients that requires confirmation. Our findings highlight the need for sex- and gender-based analyses in acute care research.

The shortage of general practice nurses is predicted to get worse in the coming years. One way of attracting new nurses to general practice is through education programmes. However, most nursing degrees do not provide enough primary care experience to students and there are barriers to general practice offering placements. South East London Training Hub has aimed to increase the number of placements on offer. The training hub aims to alleviate as much of the extra workload and pressure brought on by hosting a student as possible. This article covers some of the things being trialled, including improving training, simplifying documentation and keeping records.Nurses and managers experience barriers to hosting student nurse placements. South East London Training Hubare trialling a new placement process to overcome these barriers

Purpose: Parkruns are weekly, free, community-based, 5 km runs around open spaces, with a growing body of research indicating their social, physical and psychological benefits. Thirty-one custodial establishments in England and Wales regularly offer parkruns. The purpose of this paper is to consider prisoners' experiences of parkrun in custodial settings, and these are discussed in the context of the evidence base regarding parkrun in the community and the wider literature on prison sport, desistance, and rehabilitation culture. Design/methodology/approach: Using an inductive, qualitative approach, data was collected at three English prisons, via semi-structured interviews with 24 adult male prisoners who participated in parkrun. Data was subjected to thematic analysis. Findings: In total, five themes reflecting positive experiences associated with custodial parkrun were identified: connection with others; healthy living; a safe and predictable exercise environment; a sense of purpose; and a re-humanising experience. Factors appearing frequently in the wider parkrun research are present in the perceptions of parkrunners in custody. In addition, factors deemed important to desistance and promoting a rehabilitation culture were also found in the experiences of the sample. Practical implications: The work emphasises the successes of His Majesty’s Prison and Probation Service (HMPPS) and parkrun working in partnership to support custodial events. By highlighting the positive experiences of custodial parkrun on prisons and prisoners, the authors anticipate that their findings may encourage further sites to consider launching parkrun events and prompt existing sites to consider their events in line with efforts to promote desistance and a rehabilitation culture. Originality/value: To the best of the authors’ knowledge, this is the first paper to explore custodial parkrun. The findings indicate that custodial parkrun supports HMPPS strategic goals by offering an opportunity for prisons to promote desistance.

Purpose: This research argues that architecture knowledge is fragmented between the profession and academia as evidenced by long-standing conflicting opinions regarding desirable graduate attributes. Work-integrated learning (WIL) is one mode of education where these fragments should come together. This research seeks to address a missing part of that WIL model and understand the profession's view of what constitutes quality education as a United Nations (UN) Sustainability Development Goal (SDG). Design/methodology/approach: Utilising a three round Delphi survey of the architecture profession engaged in WIL programs, this study reports on their perspectives of the key benefits and attributes of WIL and the value of WIL experiences as part of a quality higher education system. Findings: The architecture profession confirmed the value of WIL programs as contributing to students developing an understanding of workplace culture and contexts. There was strong agreement that WIL experiences can be a valuable part of a quality education and enhance graduate employability. Challenges for practice included semester-based program timing, the length of engagement with practice and the lack of WIL program guidance by universities to prepare the profession for WIL experiences. Originality/value: While WIL has been extensively researched over the last decade, it is limited in the architecture discipline. Survey findings address the research gap in understanding the architecture profession's views as a key WIL stakeholder which is important given the rapidly changing practice environments, globalisation and the increasingly transdisciplinary context.

Aims and methodPeople diagnosed with dementia are often started on acetylcholinesterase inhibitors (AChEIs). As AChEIs can be associated with cardiac side-effects, an electrocardiogram (ECG) is sometimes requested before treatment. Previous work has suggested there is little consensus as to when or how ECGs should be obtained. This can create inconsistent practice, with patient safety, economic and practical repercussions. We surveyed 305 UK memory clinic practitioners about prescribing practice.ResultsMore than 84% of respondents completed a pulse and cardiac history before prescribing AChEIs. Opinion was divided as to who should fund and conduct ECGs. It was believed that obtaining an ECG causes patients inconvenience and delays treatment. Despite regularly interpreting ECGs, 76% of respondents did not update this clinical skill regularly.Clinical implicationsThe variation in practice observed has service-level and patient implications and raises potential patient safety concerns. Implementing national guidelines or seeking novel ways of conducting cardiac monitoring could help standardise practice.