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Right ventricular (RV) dysfunction and resultant acute right heart failure (ARHF) is a rapidly growing field of interest, driven by increasing appreciation of its contribution to heart failure morbidity and mortality. Understanding of ARHF pathophysiology has advanced dramatically over recent years and can be broadly described as RV dysfunction related to acute changes in RV afterload, contractility, preload, or left ventricular dysfunction. There are several diagnostic clinical signs and symptoms as well as imaging and hemodynamic assessments that can provide insight into the degree of RV dysfunction. Medical management is tailored to the different causative pathologies, and in cases of severe or end-stage dysfunction, mechanical circulatory support can be utilized. In this review, we describe the pathophysiology of ARHF, how its diagnosis is established by clinical signs and symptoms and imaging findings, and provide an overview of treatment options, both medical and mechanical.

Interest in the applications of music in health, social care and community settings are growing worldwide. Rare diseases are a major challenge for public health, particularly in paediatric populations. Previous research has demonstrated music and music medicine benefit children and young people’s health and wellbeing; however, this is under-researched in the paediatric rare disease context. This scoping review was conducted to explore music therapy and music medicine as tools to support children with rare diseases’ health and wellbeing within healthcare settings. The review investigated the current research on how music is used for children and young people with rare diseases and complex conditions and synthesised the resulting evidence. Results from this review suggest that music therapy and music medicine are beneficial for the health and wellbeing of children with rare diseases and complex conditions, including reduced anxiety, stress and pain during clinical procedures, and increased communication, social and coping skills and enhanced quality of life.

HIV infection is monitored through the National HIV Surveillance System (NHSS) to help improve the health of people with HIV and reduce transmission. NHSS data are routinely used at federal, state, and local levels to monitor the distribution and transmission of HIV, plan and evaluate prevention and care programs, allocate resources, inform policy development, and identify and respond to rapid transmission in the United States. We describe the expanded use of HIV surveillance data since the 2013 NHSS status update, during which time the Centers for Disease Control and Prevention (CDC) coordinated to revise the HIV surveillance case definition to support the detection of early infection and reporting of laboratory data, expanded data collection to include information on sexual orientation and gender identity, enhanced data deduplication processes to improve quality, and expanded reporting to include social determinants of health and health equity measures. CDC maximized the effects of federal funding by integrating funding for HIV prevention and surveillance into a single program; the integration of program funding has expanded the use of HIV surveillance data and strengthened surveillance, resulting in enhanced cluster response capacity and intensified data-to-care activities to ensure sustained viral suppression. NHSS data serve as the primary source for monitoring HIV trends and progress toward achieving national initiatives, including the US Department of Health and Human Services’ Ending the HIV Epidemic in the United States initiative, the White House’s National HIV/AIDS Strategy (2022-2025), and Healthy People 2030. The NHSS will continue to modernize, adapt, and broaden its scope as the need for high-quality HIV surveillance data remains.

We propose to embed time series in a latent space where pairwise Euclidean distances (EDs) between samples are equal to pairwise dissimilarities in the original space, for a given dissimilarity measure. To this end, we use auto-encoder (AE) and encoder-only neural networks to learn elastic dissimilarity measures, e.g., dynamic time warping (DTW), that are central to time series classification (Bagnall et al., 2017). The learned representations are used in the context of one-class classification (Mauceri et al., 2020) on the datasets of UCR/UEA archive (Dau et al., 2019). Using a 1-nearest neighbor (1NN) classifier, we show that learned representations allow classification performance that is close to that of raw data, but in a space of substantially lower dimensionality. This implies substantial and compelling savings in terms of computational and storage requirements for nearest neighbor time series classification.

The recent advent of highly effective anti-obesity medications (AOM) provides pediatric clinicians a powerful tool to augment the treatment of obesity and improve outcomes. The 2023 American Academy of Pediatrics guidelines state clinicians “should offer adolescents 12 years and older with obesity weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment”. This article will provide an update on the integration of AOM into practice, emphasizing clinical pearls and practical tips.

This study introduces a novel application of temporal convolutional neural networks (TCNNs) for automated emotion recognition (AER) using electrocardiogram (ECG) signals. By leveraging advanced deep learning (DL) techniques, our approach achieves the impressive classification accuracies of 98.68% for arousal and 97.30% for valence across two publicly available datasets. This methodology effectively preserves the temporal integrity of ECG signals, offering a robust framework for real-time emotion detection. Extensive preprocessing ensures high-quality input data, while cross validation confirms model generalizability. Our results demonstrate the potential of TCNN in enhancing human–computer interactions and healthcare monitoring systems through improved emotion recognition, paving the way for future applications in affective computing and wearable sensor technology.

We undertake a comprehensive investigation of the temperature (T) and injection dependence of the modal gain in 1240 nm-emitting Type-II (GaIn)As/Ga(AsSb)/(GaIn)As “W” laser active regions for 25$\leq$T$\leq$300 K. From direct measurements of the short-wavelength transparency point, which serves as a proxy for population inversion, the behaviour of the maximum gain and peak blueshift are used to highlight the different temperature dependencies of the gain at different injection regimes. We show that the thermal redshift of the peak gain at room temperature reduces from 0.53$\pm$0.03 nm/$^\circ$C under flat band conditions to 0.32$\pm$0.03 nm/$^\circ$C at threshold. These results demonstrate the significant role of injection-dependent electrostatic effects and how it may be used through design to tailor the thermal properties of semiconductor lasers employing Type-II “W” active regions.

In the aftermath of the COVID-19 pandemic, opportunities to modulate biological pathways common to the lifecycles of viruses need to be carefully considered. N-linked glycosylation in humans is mediated exclusively by the oligosaccharyltransferase complex and is frequently hijacked by viruses to facilitate infection. As such, STT3A/B, the catalytic domain of the OST complex, became an intriguing drug target with broad-spectrum antiviral potential. However, due to the critical role N-linked glycosylation plays in a number of fundamental human processes, the toxicological ramifications of STT3A/B inhibition required attention commensurate to that given to antiviral efficacy. Herein, we describe how known STT3A/B inhibitor NGI-1 inspired the discovery of superior tool compounds which were evaluated in in vitroefficacy and translational safety (e.g., CNS, cardiovascular, liver) studies. The described learnings will appeal to those interested in the therapeutic utility of modulating N-linked glycosylation as well as the broader scientific community.

The performance of metal and polymer foams used in inertial confinement fusion (ICF), inertial fusion energy (IFE), and high-energy-density (HED) experiments is currently limited by our understanding of their nanostructure and its variation in bulk material. We utilized an X-ray-free electron laser (XFEL) together with lensless X-ray imaging techniques to probe the 3D morphology of copper foams at nanoscale resolution (28 nm). The observed morphology of the thin shells is more varied than expected from previous characterizations, with a large number of them distorted, merged, or open, and a targeted mass density 14% less than calculated. This nanoscale information can be used to directly inform and improve foam modeling and fabrication methods to create a tailored material response for HED experiments.

For healthspan and lifespan, ERK, AMPK and mTORC1 represent critical pathways and inflammation is a centrally important hallmark1–7. Here we examined whether IL-11, a pro-inflammatory cytokine of the IL-6 family, has a negative effect on age-associated disease and lifespan. As mice age, IL-11 is upregulated across cell types and tissues to regulate an ERK–AMPK–mTORC1 axis to modulate cellular, tissue- and organismal-level ageing pathologies. Deletion of Il11or Il11ra1protects against metabolic decline, multi-morbidity and frailty in old age. Administration of anti-IL-11 to 75-week-old mice for 25 weeks improves metabolism and muscle function, and reduces ageing biomarkers and frailty across sexes. In lifespan studies, genetic deletion of Il11extended the lives of mice of both sexes, by 24.9% on average. Treatment with anti-IL-11 from 75 weeks of age until death extends the median lifespan of male mice by 22.5% and of female mice by 25%. Together, these results demonstrate a role for the pro-inflammatory factor IL-11 in mammalian healthspan and lifespan. We suggest that anti-IL-11 therapy, which is currently in early-stage clinical trials for fibrotic lung disease, may provide a translational opportunity to determine the effects of IL-11 inhibition on ageing pathologies in older people.

ABSTRACTThis study aimed to use a coach-led digital health platform to mitigate burnout and enhance wellbeing among hospital workers. Individual interviews were conducted with 11 healthcare workers to explore their experiences of working with a coach through text-based communication on a digital support platform. Interviews were analysed using thematic analysis. Three overarching themes were identified: (1) Human-centred Conversation, Facilitated Awareness, (2) Learning and Growth, (3) Forward Momentum in the pillars of Lifestyle Medicine. Participants had a positive human-centered connection with their coach and felt safe to communicate openly with her via online chat messages. The coach facilitated participants’ awareness, learning and growth by helping them to identify the goals they wanted to achieve. Participants experienced forward momentum in the pillars of Lifestyle Medicine, including sleep, relationships, meaning and purpose in life, exercise, eating well, along with reduced loneliness and burnout. This study found that participants can experience an inherently human-centred connection through text-based communication with an online coach. There were some limits to this connection, including individual preferences and beliefs in relation to the digital means of communication. Participants felt connected to their coach and experienced benefits that extended beyond achieving individual goals to improving their lifestyle and wellbeing.

Artificial intelligence (AI) and related technologies are transforming many consumption activities, powering breakthroughs that expand the human experience by enhancing human capabilities, performance, and creativity. While this explains the consumer enthusiasm and rapid adoption of these technologies, AI systems can also have the opposite effect: reducing and constraining the range of experiences that are available to consumers. This article examines the mechanisms through which AI can constrain the human experience, considering individual, interpersonal, and societal processes. Our analysis uncovers a complex interplay between the advantages of AI and its inadvertent negative repercussions, which potentially restrict human autonomy, self-identity, relational dynamics, and social behavior. In this article, we propose three different mechanisms at the core of these constraining forces: parametric reductionism, agency transference, and regulated expression. Our exploration of these mechanisms highlights the risks connected to system design and points to questions and implications for future researchers and policymakers.

Sensory prediction allows the brain to anticipate and parse incoming self-generated sensory information from externally generated signals. Sensory prediction breakdowns may contribute to perceptual and agency abnormalities in psychosis (hallucinations, delusions). The pons, a central node in a cortico-ponto-cerebellar-thalamo-cortical circuit, is thought to support sensory prediction. Examination of pons connectivity in schizophrenia and its role in sensory prediction abnormalities is lacking.

Abstract:This essay examines how, whether, and in what sense Christ had human passions. This question comes out of Anselm’s work, not only Cur Deus homo, but also his portrayal of the importance of the passions in his prayers and meditations, and becomes a standard question in the Latin High Middle Ages. The essay considers the role of Stoic and Aristotelian accounts of the passions as influencing Franciscan thinkers and contrasts that with the account of Christ’s passions given by Thomas Aquinas. The case of Jesus’s suffering is considered here as a reflection on the nature of the human passions (rather than Jesus’s divine nature), and where and how the passions for us mere mortals are connected to human nature vs. human sinfulness taken on, or not, by Christ as the sinless and perfect man. The essay concludes that Aquinas’ account of passions for human beings in this life and Christ during his life captures better than that of Alexander of Hales or Bonaventure what Anselm seems to be getting at, not just in his soteriology but also in his account of human passions as an essential part of spiritual awakening and growth.

AbstractObjectiveMigraine and irritable bowel syndrome (IBS) can be difficult-to-treat comorbidities that may be driven by underlying gut–brain axis dysfunction. This report describes utilization of a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet (LFD) in a patient with refractory migraine and co-occurring IBS.MethodsAfter unremarkable physical and neurological examinations, a 57-year-old woman with IBS and chronic migraine was started on a LFD under the guidance of a registered dietician. Psychometrically validated surveys administered at baseline and initial follow-up assessed patient-reported outcomes related to migraine and IBS symptoms.ResultsAt baseline, the patient reported 80/90 migraine days with average pain of 8/10, a Migraine Disability Assessment (MIDAS) score of 33, and Headache Impact Test-6 (HIT-6) score of 64, the latter 2 scores indicating severe disability. Baseline IBS symptom severity was noted at 9/10. Within 1 week on a LFD, the patient’s IBS symptoms and migraines improved in both frequency and intensity of episodes. After 5 weeks on a LFD elimination, the patient’s clinical improvement continued and she reported significant reduction in migraines, with average pain of 1/10 and IBS severity of 3/10. The patient also improved from severe to minimal levels of disability on validated measures (MIDAS, HIT-6, and IBS Patient Global Impression of Change).ConclusionThis is the first case report detailing successful initial treatment of migraine and co-occurring IBS utilizing a dietician-guided LFD. There are a number of important reasons for potential improvement in these gut–brain axis disorders which are reviewed as well as an implication for long-term management and food reintroduction. Larger, randomized trials evaluating a LFD in diverse individuals with migraine and co-occurring IBS are warranted to help confirm these results.

Purpose:An ageing population and a global pandemic has placed greater demands on palliative care services. Numerous studies describe the patient experience in palliative care, however, few explore the healthcare professional’s experience of caring in this setting. This study explored the emotional challenges faced by palliative care professionals working in adult hospice services in Ireland.Design/methodology/approach:A narrative phenomenological approach was adopted, using interpretative phenomenological analysis to analyse results from five participants’ semi-structured interviews.Findings:The type of challenge experienced reflected the impact it had on the participant’s emotional wellbeing. Challenges perceived as achievable contributed to high levels of emotional wellbeing. These challenges often offered the opportunity for skill development and elicited positive feelings. Challenges perceived as uncontrollable negatively impacted the professional’s emotional wellbeing and increased their risk of burnout. Examples of this included the shift in service provision and professional expectations. The challenges palliative care professionals experience on a daily basis can negatively or positively impact their emotional wellbeing.Conclusion:Overall, this study highlighted challenges and their impacts experienced by palliative care professionals, illustrating key areas for improvement to prioritise staff wellbeing.

Background: Duchenne muscular dystrophy (DMD) and related dystrophinopathies are neuromuscular conditions with great unmet medical needs that require the development of effective medical treatments.Objective: To aid sponsors in clinical development of drugs and therapeutic biological products for treating DMD across the disease spectrum by integrating advancements, patient registries, natural history studies, and more into a comprehensive guidance.Methods: This guidance emerged from collaboration between the FDA, the Duchenne community, and industry stakeholders. It entailed a structured approach, involving multiple committees and boards. From its inception in 2014, the guidance underwent revisions incorporating insights from gene therapy studies, cardiac function research, and innovative clinical trial designs.Results: The guidance provides a deeper understanding of DMD and its variants, focusing on patient engagement, diagnostic criteria, natural history, biomarkers, and clinical trials. It underscores patient-focused drug development, the significance of dystrophin as a biomarker, and the pivotal role of magnetic resonance imaging in assessing disease progression. Additionally, the guidance addresses cardiomyopathy’s prominence in DMD and the burgeoning field of gene therapy.Conclusions: The updated guidance offers a comprehensive understanding of DMD, emphasizing patient-centric approaches, innovative trial designs, and the importance of biomarkers. The focus on cardiomyopathy and gene therapy signifies the evolving realm of DMD research. It acts as a crucial roadmap for sponsors, potentially leading to improved treatments for DMD.

Duchenne muscular dystrophy (DMD) and related dystrophinopathies are neuromuscular conditions with great unmet medical needs that require the development of effective medical treatments. To aid sponsors in clinical development of drugs and therapeutic biological products for treating DMD across the disease spectrum by integrating advancements, patient registries, natural history studies, and more into a comprehensive guidance. This guidance emerged from collaboration between the FDA, the Duchenne community, and industry stakeholders. It entailed a structured approach, involving multiple committees and boards. From its inception in 2014, the guidance underwent revisions incorporating insights from gene therapy studies, cardiac function research, and innovative clinical trial designs. The guidance provides a deeper understanding of DMD and its variants, focusing on patient engagement, diagnostic criteria, natural history, biomarkers, and clinical trials. It underscores patient-focused drug development, the significance of dystrophin as a biomarker, and the pivotal role of magnetic resonance imaging in assessing disease progression. Additionally, the guidance addresses cardiomyopathy’s prominence in DMD and the burgeoning field of gene therapy. The updated guidance offers a comprehensive understanding of DMD, emphasizing patient-centric approaches, innovative trial designs, and the importance of biomarkers. The focus on cardiomyopathy and gene therapy signifies the evolving realm of DMD research. It acts as a crucial roadmap for sponsors, potentially leading to improved treatments for DMD.

AbstractThis article presents a framework to design lesson plans for elementary science teachers using insights from a summer-long research experience for teachers (RET) workshop (National Science Foundation 2021) to learn strategies to weave ISK (and WMS) into environmental science curriculum and instruction. While ISK has also led to technologies that optimize agriculture, stewardship of the land, and foraging and harvesting plants and animals, these activities should be implemented in sustainable reciprocity with the natural world, focusing on both conservation as well as preservation. Incorporating ISK to the elementary science curriculum will not only reconcile its historical absence but also helps to overcome 21st century challenges related to cultivating a sense of environmental stewardship and encouraging sustainable habits among youth as well as developing students' awareness of under-represented and diverse means of thinking about the natural world from ISK perspectives. This article, we explore ISK, WMS, and relationships therein and examine a framework to guide ISK lesson development in environmental science for an elementary audience that honors and amplifies the importance of ISK as intertwined with WMS standards and curricula. Further, one example lesson from the RET is provided on bison bone usage from the Apsalooké and other Plains Indian nations.

Background/Aims:The COVID-19 pandemic coincided with a randomised-controlled trial of an online-supported self-management intervention for fatigue, pain and urgency in inflammatory bowel disease (IBD). The aim of the present study was to investigate how the pandemic affected engagement with the IBD-BOOST programme.Methods:Intervention participants were invited to complete an online survey at 6-month follow-up, including both pre-defined and open-ended questions. A mixed methods quantitative and qualitative analyses were conducted. People who had participated in the online intervention (n= 354) were invited to answer questions about the impact of COVID-19 on their ability to engage with the online interventionResults:A total of 171 (48.31%) responded to the survey, with their experiences of the pandemic encompassing both negative and positive impacts on their engagement, as well as those who felt that the pandemic had no impact. For those who reported negative impact (19.30%): the pandemic created additional work and home-life responsibilities, the pandemic-induced emotional and psychological burden contributed to decreased participation, and engagement was reduced due to direct COVID-19 infection. For those who reported a positive impact (9.94%): the pandemic allowed for increased time availability due to pandemic-induced lifestyle changes. For those who felt the pandemic had no impact (50.29%): adaptability helped to maintain their engagement. The remaining 20.47% of participants reported that they were uncertain, or that their involvement varied.Conclusion:For some participants, the pandemic negatively impacted their engagement. However, 60% reported that the pandemic had either no or a positive impact on their engagement with IBD-BOOST, indicating the resilience of online delivery of behavioural interventions.

Rising prices are a major cause of increased health care spending and health insurance premiums in the US. Hospital prices, specifically—for both inpatient and outpatient care—are the largest driver of rising health care spending in the commercial insurance market. As a result, policy makers and employers are increasingly interested in understanding the determinants of hospital prices. Hospitals serving as trauma centers are often endowed by regulators with monopoly power over trauma services in their geographic areas, and this monopoly power may spill over to nontrauma services. This study focused on the growing number of designated trauma centers and how trauma center status affects hospital prices for other, nontrauma services. We found that hospitals designated as trauma centers charged higher prices for nontrauma inpatient admissions and nontrauma emergency department visits when compared with hospitals that were not designated as trauma centers, even after controlling for potential confounders.