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Abstract Remdesivir therapy has been declared as efficient in the early stages of Covid-19. Of the 339 patients (males 55.8%, age 71(59;77) years) with a detectable viral load, 140 were treated with remdesivir (of those 103 in the ICU and 57 immunosuppressed) and retrospectively compared with 199 patients (of those 82 in the ICU and 28 immunosuppressed) who were denied therapy due to advanced Covid-19. The viral load was estimated by detecting nucleocapsid antigen in serum (n = 155, median 217(28;1524)pg/ml), antigen in sputum (n = 18, COI 18(4.6;32)), nasopharyngeal antigen (n = 44, COI 17(8;35)) and the real-time PCR (n = 122, Ct 21(18;27)). After adjustment for confounders, patients on remdesivir had better 12-month survival (HR 0.66 (0.44;0.98), p = 0.039), particularly when admitted to the ICU (HR 0.49 (0.29;0.81), p = 0.006). For the immunocompromised patients, the difference did not reach statistical significance (HR 0.55 (0.18;1.69), p = 0.3). The other most significant confounders were age, ICU admission, mechanical ventilation, leukocyte/lymphocyte ratio, admission creatinine and immunosuppression. The impact of monoclonal antibodies or previous vaccinations was not significant. Despite frequent immune suppression including haemato-oncology diseases, lymphopenia, and higher inflammatory markers in the remdesivir group, the results support remdesivir administration with respect to widely available estimates of viral load in patients with high illness severity.

In this study, we utilised ground-based in situ measurements of the aerosol chemical composition and particle size distribution, along with meteorological data from the European Centre for Medium-Range Weather Forecasts (ECMWF), to predict vertical profiles of aerosol optical properties, including the aerosol scattering coefficient, backscatter coefficient, extinction coefficient, and lidar ratio. The predicted ambient profiles were compared to retrievals by a multi-wavelength Raman lidar during the Ruisdael Land–Atmosphere Interactions Intensive Trace-gas and Aerosol (RITA) campaign in the Netherlands in 2021 for 26 time periods of approximately 1 h each. Predicted and retrieved extensive aerosol properties (scattering, backscatter, and extinction coefficient) were comparable only approximately 35 % of the time, mostly under the condition of well-mixed boundary layers. In this case, ground-based measurements can provide a way to extend extinction profiles to lower altitudes, where they cannot be retrieved, and to verify the lidar-measured profiles. Accurate representation of hygroscopic growth is required for adjusting the dry size distribution to ambient size distribution, and the estimated relative humidity profile may have a substantial influence on the shape of the calculated profiles. On the other hand, the lidar ratio profiles predicted by ground-based data also compared reasonably well to the retrieved lidar profiles (starting at 800 m) for conditions where the predicted and retrieved backscatter profiles differed considerably. The difference in the predicted and retrieved lidar ratio is usually less than ±30 %. Our study thus shows that, for well-mixed boundary layers, a representative lidar ratio can be estimated from ground-based in situ measurements of chemical composition and dry size distribution. This approach offers a method of providing lidar ratios calculated from independent in situ measurements for simple backscatter lidars or at times when Raman lidar profiles cannot be measured (e.g. during the daytime). It only uses data that are routinely available at aerosol measurement stations and is therefore not only useful for further validating lidar measurements but also for bridging the gap between in situ measurements and lidar remote sensing.

The employment of biomolecular templates for the synthesizing nanohybrid constructs is expanding, driven by their prospective uses in biosensing and biomedical fields. Gold nanoparticles (AuNPs) and, in particular, their assemblies are especially preferred for Surface Enhanced Raman Spectroscopy (SERS) because of their ability to amplify Raman signals through localized surface plasmon resonances, thus enabling the detection of molecules at exceedingly low concentrations. Our investigative approach is dedicated to studing the role of cysteine mutants in the nucleation and assembly of AuNPs on Tobacco mosaic virus (TMV-C, carrying T158C mutation) scaffolds. Employing biomineralization and direct grafting methods, we synthesized these nanohybrids and examined them using conventional transmission electron microscopy (TEM), in situ liquid TEM, and fluorescence spectroscopy. We demonstrated that the syntheses obtained with TMV-C give denser plasmonic nanostructures, with is ideal for SERS applications. The SERS performances of these novel nanohybrids with various AuNPs sizes and densities were evaluated, revealing excellent enhancement factors for the nanosystems obtained by direct grafting that highlight their potential for the detection of biomolecules in solution.

Abstract Striosomes and matrix are two compartments that comprise the striatum, each having its own distinct immunohistochemical properties, function, and connectivity. It is currently not clear whether prodromal or early manifest Parkinson’s disease (PD) is associated with any striatal matrix or striosomal abnormality. Recently, a method of striatal parcellation using probabilistic tractography has been described and validated, using the distinct connectivity of these two compartments to identify voxels with striosome- and matrix-like connectivity. The goal of this study was to use this approach in tandem with DAT-SPECT, a method used to quantify the level of nigrostriatal denervation, to analyze the striatum in populations of de novo diagnosed, treatment-naïve patients with PD, isolated REM behavioral disorder (iRBD) patients, and healthy controls. We discovered a shift in striatal connectivity, which showed correlation with nigrostriatal denervation. Patients with PD exhibited a significantly higher matrix-like volume and associated connectivity than healthy controls and higher matrix-associated connectivity than iRBD patients. In contrast, the side with less pronounced nigrostriatal denervation in PD and iRBD patients showed a decrease in striosome-like volume and associated connectivity indices. These findings could point to a compensatory neuroplastic mechanism in the context of nigrostriatal denervation and open a new avenue in the investigation of the pathophysiology of Parkinson’s disease.

The recently developed time-of-flight aerosol chemical speciation monitor with a capture vaporizer and a PM2.5 aerodynamic lens (TOF-ACSM-CV-PM2.5) aims to improve the collection efficiency and chemical characterization of aerosol particles with a diameter smaller than 2.5 µm. In this study, comprehensive cross-comparisons were performed between real-time online measurements and offline filter analysis with 24 h collection time. The goal was to evaluate the capabilities of the TOF-ACSM-CV-PM2.5 lens, as well as the accuracy of the TOF-ACSM-CV-PM2.5. The experiments were conducted at Cabauw Experimental Site for Atmospheric Research (CESAR) during the RITA-2021 campaign. The non-refractory fine particulate matter (PM1.0 and PM2.5) was measured by two collocated TOF-ACSM-CV-PM2.5 instruments by placing them behind a PM2.5 and PM1.0 inlet, respectively. A comparison between the ACSMs and PM2.5 and PM1.0 filter samples showed a much better accuracy than ±30 % less given in the previous reports, with average differences less than ±10 % for all inorganic chemical species. In addition, the ACSMs were compared to the Monitoring Instrument for Aerosol and Gas (MARGA) (slope between 0.78 and 0.97 for inorganic compounds, R2≥ 0.93) and a mobility particle size spectrometer (MPSS), measuring the particle size distribution from around 10 to 800 nm (slope was around 1.00, R2= 0.91). The intercomparison of the online measurements and the comparison between the online and offline measurements indicated a low bias (< 10 % for inorganic compounds) and demonstrated the high accuracy and stability of the TOF-ACSM-CV-PM2.5 lens for the atmospheric observations of particle matter. The two ACSMs exhibited an excellent agreement, with differences less than 7 %, which allowed a quantitative estimate of PM1.0 vs. PM2.5 chemical composition. The result showed that the PM1.0 accounted for about 70 %–80 % of the PM2.5 on average. The NO3 mass fraction increased, but the organic carbon (OC) mass fraction decreased from PM1.0 to PM2.5, indicating the size dependence on chemical composition.

Abstract Background Glutathione S-transferases (GSTs) play important roles in protecting cells against oxidative stress and toxic chemicals. This study aimed to investigate the distribution of GSTM1, GSTT1, and GSTP1 variants and their roles in periodontitis susceptibility in a Caucasian population. Methods We analyzed 406 participants, including 204 healthy controls and 203 periodontitis patients. A multiplex polymerase chain reaction (PCR) approach was used to analyze GSTM1 and GSTT1 loci. GSTP1 variants were detected by PCR-haplotyping method in a subgroup of participants (N = 350). Chi-square or Fisher´s exact tests were used to compare genotypic and allelic differences. The Bonferroni method was applied to correct for multiple comparisons (pcorr). Results The GSTM1 genotype distribution did not differ significantly between controls and periodontitis patients (p = 0.44). Additionally, the wild/null genotypes of GSTT1, Ile105Val and Ala114Val frequencies of GSTP1 were not significantly different between the two groups after correction for multiple comparisons (p = 0.05, p = 0.55, p = 0.02, pcorr>0.05, respectively). The GSTM1 and GSTP1 Ile105Val gene variants were similarly distributed between non-smokers and smokers in both groups (p = 0.38, p = 0.20, and p = 0.14, p = 0.35, respectively). However, the wild genotype of the GSTT1 and Ala114Ala variant of the GSTP1 genes were present more frequently in non-smoking periodontitis patients than in non-smoking controls (p = 0.03, pcorr>0.05, and p = 0.009, pcorr>0.05, respectively) although their frequencies did not differ between smoking periodontitis patients and smoking controls (p = 0.23, p = 0.68, respectively). Conclusions This study in a Czech Caucasian population did not confirm a highly significant association between GST gene variants and susceptibility to periodontitis, as previously reported by Arshad and colleagues in Pakistanis. However, a weak relationship between GSTT1 and GSTP1 rs1138272 polymorphisms and periodontitis in non-smokers was observed.

Samuel N Rodgers-Melnick,1,2 Robert J Trager,1 Thomas E Love,2– 4 Jeffery A Dusek5 1Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA; 2Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA; 4Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA; 5Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USACorrespondence: Samuel N Rodgers-Melnick, University Hospitals Connor Whole Health, 11100 Euclid Avenue, Wearn 548A, Cleveland, OH, 44106, USA, Tel +1 216 844 7727, Fax +1 216 201 6220, Email Samuel.RodgersMelnick@UHhospitals.orgObjective: To examine variables associated with engagement in (1) integrative health and medicine (IHM) and (2) nonpharmacologic modalities rather than opioids among United States adults with chronic pain.Methods: Using the 2019 National Health Interview Survey, we examined sociodemographic, pain, and mental health predictors of (1) the sum of IHM modalities (ie, chiropractic care, yoga/Tai Chi, massage, or meditation/guided imagery) used to manage pain and (2) exclusive engagement in nonpharmacologic pain management modalities (ie, IHM, a chronic pain self-management program, support groups, or physical, rehabilitative, occupational, or talk therapy) or opioids in the past 3 months.Results: Metropolitan residency, higher family income, higher education levels, increased number of pain locations, and increased frequency of pain limiting life/work activities were associated with increased odds of IHM engagement. Older age, male sex, non-Hispanic Black/African American race/ethnicity, and daily opioid use were associated with decreased odds of IHM engagement. Older age, male sex, and increased depressive symptoms were associated with decreases in the count of IHM modalities used to manage pain. Metropolitan residency, higher family income, and higher education levels were associated with increased odds of exclusive nonpharmacologic modality engagement. Older age and increasing frequency of pain limiting life/work activities were associated with decreased odds of exclusive nonpharmacologic modality engagement.Conclusions: We identified several contrasts between factors prevalent among individuals with chronic pain and factors associated with engagement in nonpharmacologic and IHM modalities. These results support efforts to address barriers to accessing these modalities among subpopulations of adults with chronic pain (eg, older adults, individuals identifying as Black/African American, rural residents, and those with lower levels of education and income).Plain Language Summary: This study examined factors influencing the use of integrative health and non-drug treatments for chronic pain in the United States. Results revealed that metropolitan residence, higher income, and education were associated with increased use of these treatments, while older age, male sex, daily opioid use, and non-Hispanic Black/African American ethnicity were associated with decreased use. The findings emphasize the importance of addressing barriers to these forms of care, especially among older adults, Black/African American individuals, and those with higher depressive symptoms and lower education and income levels, who are more likely to have chronic pain.Keywords: integrative medicine, chronic pain, nonpharmacologic, opioids

Abstract Background Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years’ follow-up. Methods We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), and explored cumulative incidence of reoperation and the number of SMT follow-up visits. Results Following propensity matching there were 378 patients per cohort (mean age 61 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT: 7%; usual care: 13%), yielding an RR (95% CIs) of 0.55 (0.35–0.85; P = 0.0062). In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit (median = 6). Conclusions This study found that adults experiencing LSR at least one year after lumbar discectomy who received SMT were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT. While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance. We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture. Registration Open Science Framework ( https://osf.io/vgrwz ).

Background: Acupuncture shows promise as an effective nonpharmacologic option for reduction of acute pain in the emergency department (ED). Following CONSORT and STRICTA guidelines, randomized controlled trials (RCTs) generally report intervention details and acupoint options, but fidelity to acupuncture interventions, critical to reliability in intervention research, is rarely reported. Methods: ACUITY is an NCCIH-funded, multi-site feasibility RCT of acupuncture in 3 EDs (Cleveland, Nashville, and San Diego). ACUITY acupuncturists were trained in study design, responsive acupuncture manualization protocol, logistics and real-time recording of session details via REDCap forms created to track fidelity. Results: Across 3 recruiting sites, 79 participants received acupuncture: 51 % women, 43 % Black/African American, with heterogeneous acute pain sites at baseline: 32 % low back, 22 % extremity, 20 % abdominal, 10 % head. Pragmatically, participants were treated in ED common areas (52 %), private rooms (39 %), and semi-private rooms (9 %). Objective tracking found 98 % adherence to the six components of the acupuncture manualization protocol: staging, number of insertion points (M = 13.2, range 2–22), needle retention time (M = 23.5 min, range 4–52), session length (M = 40.3 min, range 20–66), whether general recommendations were provided and completion of the session form. Conclusion: To the best of our knowledge, this is the first RCT to assess and report fidelity to an acupuncture protocol. Fidelity monitoring will be fundamental for ACUITY2, which would be a future definitive, multi-site RCT. Furthermore, we recommend that fidelity to acupuncture interventions be added to CONSORT and STRICTA reporting guidelines in future RCTs. Protocol registration: The protocol of this study is registered at clinicaltrials.gov: NCT04880733.

Coastal water level information is crucial for understanding flood occurrences and changing risks. Here, we validate the preliminary version (0.9) of NOAA’s Coastal Ocean Reanalysis (CORA), which is a 43-year reanalysis (1979–2021) of hourly coastal water levels for the Gulf of Mexico and Atlantic Ocean (i.e., the Gulf and East Coast region, or GEC). CORA-GEC v0.9 was conducted by the Renaissance Computing Institute using the coupled ADCIRC+SWAN coastal circulation and wave model. The model uses an unstructured mesh of nodes with varying spatial resolution that averages 400 m near the coast and is much coarser in the open ocean. Water level variations associated with tides and meteorological forcing are explicitly modeled, while lower-frequency water level variations are included by dynamically assimilating observations from NOAA’s National Water Level Observation Network. We compare CORA to water level observations that were either assimilated or not, and find that the reanalysis generally performs better than a state-of-the-art global ocean reanalysis (GLORYS12) in capturing the variability on monthly, seasonal, and interannual timescales as well as the long-term trend. The variability of hourly non-tidal residuals is also shown to be well resolved in CORA when compared to water level observations. Lastly, we present a case study of extreme water levels and coastal inundations around Miami, Florida to demonstrate an application of CORA for studying flood risks. Our assessment suggests that NOAA’s CORA-GEC v0.9 provides valuable information on water levels and flooding occurrence from 1979–2021 in areas that are experiencing changes across multiple time scales. CORA potentially can enhance flood risk assessment along parts of the U.S. Coast that do not have historical water level observations.

The threat posed by emerging infectious diseases is a major concern for global public health, animal health and food security, and the role of birds in transmission is increasingly under scrutiny. Each year, millions of mass-reared game-farm birds are released into the wild, presenting a unique and a poorly understood risk to wild and susceptible bird populations, and to human health. In particular, the shedding of enteric pathogens through excrement into bodies of water at shared migratory stop-over sites, and breeding and wintering grounds, could facilitate multi-species long-distance pathogen dispersal and infection of high numbers of naive endemic birds annually. The Mallard (Anas platyrhynchos) is the most abundant of all duck species, migratory across much of its range, and an important game species for pen-rearing and release. Major recent population declines along the US Atlantic coast has been attributed to game-farm and wild mallard interbreeding and the introduction maladaptive traits into wild populations. However, pathogen transmission and zoonosis among game-farms Mallard may also impact these populations, as well as wildlife and human health. Here, we screened 16 game-farm Mallard from Wisconsin, United States, for enteric viral pathogens using metatranscriptomic data. Four families of viral pathogens were identified – Picobirnaviridae (Genogroup I), Caliciviridae (Duck Nacovirus), Picornaviridae (Duck Aalivirus) and Sedoreoviridae (Duck Rotavirus G). To our knowledge, this is the first report of Aalivirus in the Americas, and the first report of Calicivirus outside domestic chicken and turkey flocks in the United States. Our findings highlight the risk of viral pathogen spillover from peri-domestically reared game birds to naive wild bird populations.

Parkinson's disease (PD) is a common neurodegenerative disease, and apart from a few rare genetic causes, its pathogenesis remains largely unclear. Recent scientific interest has been captured by the involvement of iron biochemistry and the disruption of iron homeostasis, particularly within the brain regions specifically affected in PD. The advent of Quantitative Susceptibility Mapping (QSM) has enabled non-invasive quantification of brain iron in vivo by MRI, which has contributed to the understanding of iron-associated pathogenesis and has the potential for the development of iron-based biomarkers in PD. This review elucidates the biochemical underpinnings of brain iron accumulation, details advancements in iron-sensitive MRI technologies, and discusses the role of QSM as a biomarker of iron deposition in PD. Despite considerable progress, several challenges impede its clinical application after a decade of QSM studies. The initiation of multi-site research is warranted for developing robust, interpretable, and disease-specific biomarkers for monitoring PD disease progression.

It is undeniable that citizen science contributes to the advancement of various fields of study. There are now software tools that facilitate the development of citizen science apps. However, apps developed with these tools rely on individual human skills to correctly collect useful data. Machine learning (ML)–aided apps provide on-field guidance to citizen scientists on data collection tasks. However, these apps rely on server-side ML support, and therefore need a reliable internet connection. Furthermore, the development of citizen science apps with ML support requires a significant investment of time and money. For some projects, this barrier may preclude the use of citizen science effectively. We present a platform that democratizes citizen science by making it accessible to a much broader audience of both researchers and participants. The SmartCS platform allows one to create citizen science apps with ML support quickly and without coding skills. Apps developed using SmartCS have client-side ML support, making them usable in the field, even when there is no internet connection. The client-side ML helps educate users to better recognize the subjects, thereby enabling high-quality data collection. We present several citizen science apps created using SmartCS, some of which were conceived and created by high school students.

Abstract Synucleinopathies‐related disorders such as Lewy body dementia (LBD) and isolated/idiopathic REM sleep behavior disorder (iRBD) have been associated with neuroinflammation. In this study, we examined whether the human leukocyte antigen (HLA) locus plays a role in iRBD and LBD. In iRBD, HLA‐DRB1*11:01 was the only allele passing FDR correction (OR = 1.57, 95% CI = 1.27–1.93, p = 2.70e‐05). We also discovered associations between iRBD and HLA‐DRB1 70D (OR = 1.26, 95%CI = 1.12–1.41, p = 8.76e‐05), 70Q (OR = 0.81, 95%CI = 0.72–0.91, p = 3.65e‐04) and 71R (OR = 1.21, 95%CI = 1.08–1.35, p = 1.35e‐03). Position 71 (pomnibus = 0.00102) and 70 (pomnibus = 0.00125) were associated with iRBD. Our results suggest that the HLA locus may have different roles across synucleinopathies.

Aerosol formation acts as a sink for gas-phase atmospheric species that controls their atmospheric lifetime and environmental effects. To investigate aerosol formation and evolution in the Netherlands, a hybrid positive matrix factorization (PMF) analysis was conducted using observations from May, June, and September 2021 collected in the rural site of Cabauw in the central part of the Netherlands. The hybrid input matrix consists of the full organic mass spectrum acquired from a time-of-flight aerosol chemical speciation monitor (ToF-ACSM), ACSM inorganic species concentrations, and binned particle size distribution concentrations from a scanning mobility particle sizer (SMPS). These hybrid PMF analyses discerned four factors that describe aerosol composition variations: two size-driven factors that are related to new particle formation (NPF) and growth (F4 and F3), as well as two bulk factors driven by composition, not size (F2 and F1). The distribution of chemical species across these factors shows that different compounds are responsible for nucleation and growth of new particles. The smallest-diameter size factor (F4) contains ammonium sulfate and organics and typically peaks during the daytime. Newly formed particles, represented by F4, are mainly correlated with wind from the southwesterly–westerly and easterly sectors that transport sulfur oxides (SOx), ammonia (NH3), and organic precursors to Cabauw. As the particles grow from F4 to F3 and to bulk factors, nitrate and organics play an increasing role, and the particle loading diurnal cycle shifts from daytime to a nighttime maximum. Greater organics availability makes secondary organic aerosol (SOA) more influential in summertime aerosol growth, principally due to volatility differences produced by seasonal variation in photooxidation and temperature.

Research Purpose: This study aimed to evaluate the “Master Plan” of the city of Rio de Janeiro, RJ, Brazil, from the perspective of Urbanism, whose good practices, when applied, outline the quality of life of the population and the development of a city. Methodology: A literary review and documentary, descriptive and historical analysis were carried out in academic databases, online data from the City of Rio de Janeiro and other public bodies. The Master Plans (PD) of the city were consulted from 1992, the year of creation of the first PD of Rio de Janeiro. Only the PD that contemplated social and sustainable policies that provide an improvement in the quality of life were analyzed, using the following descriptors “Master Plan”,“Strategic Master Plan”, “Strategic Planning”, and elimination of articles that dealt with issues away from Urbanism. Findings: The research showed that although the PD of the city of Rio de Janeiro may be late or poorly managed, it still presents itself as a fair, democratic and sustainable way to conduct good practices of Municipal Public Governance, serving as a tool for planning medium and long-term goals. It is worth noting that such governance, since the 19th century, has been accumulating plans, projects and urban legislation that overlap, but do not resolve the ills of a city that has witnessed rapid and disorderly growth. Originality/Value: In order to have a Sustainable Public Governance in the city of Rio de Janeiro, it is essential to use a Master Plan, elaborated with the principles widely presented and compiled in this study.

Abstract REM sleep without atonia (RWA) is the hallmark of isolated REM sleep behavior disorder (iRBD) and is caused by neurodegeneration of brainstem structures. Previously, quantitative susceptibility mapping (QSM) was shown to detect microstructural tissue changes in neurodegenerative diseases. The goal of the study was to compare brainstem magnetic susceptibility (MS) in iRBD and controls using the voxel-based QSM approach and to examine the association between brainstem MS and severity of RWA in iRBD. Sixty iRBD patients and 41 healthy controls were included in the study. Phasic, tonic, mixed RWA and SINBAR score was quantified. QSM maps were reconstructed with QSMbox software from a multi-gradient-echo sequence acquired at 3T MRI system and normalized using a custom T1 template. Voxel-based analysis with age and gender as covariates was performed using a two-sample t-test model for between-group comparison and using a linear regression model for association with the RWA parameters. Statistical maps were generated using threshold free cluster enhancement with p-value p

The various specializations available to nurses represent an investment geared toward providing more qualified patient care. However, little is known about the attitudes of specialized nurses toward multidisciplinarity. The purpose of this study was to investigate nurses' perceptions of multidisciplinarity in the field of specialist nurses, as well as to determine how specialization is associated with improved patient care and nurses' age in a low-resource setting in Southeast Brazil. This cross-sectional study included 70 nurses aged ≥18 years with at least one nursing specialty working at the Regional Health Superintendence of Manhuaçu, Minas Gerais, Brazil. The study participants responded to questions about specialization and its importance in the field of health care. The majority of nurse specialists (84.3%) were between the ages of 20 and 40, and 31.4 percent worked in family health. Eighty percent of nurse specialists agreed that nursing specialization was important. More than 75% agreed that specialization promotes higher quality care and that multidisciplinarity is critical for improving patient care. Seventy percent of participants distrusted online health information. There is a relationship between the importance of having a specialty and better patient care (τb=0.293, p=0.002), and between being a specialist nurse and age (τb=-0.272, p=0.004). Nurses have embraced the concept of multidisciplinarity as a way to improve healthcare. However, they were concerned about the qualifications for nursing specialties.

ObjectiveTriple A syndrome, caused by autosomal recessively inherited mutations in the AAAS gene is characterized by alacrima, achalasia, adrenal insufficiency, and neurological impairment. To the best of our knowledge, no patients of both sexes have been reported to have offspring. Our aim was to assess the causes of infertility in male patients with this multisystemic syndrome, and to present a female patient that spontaneously conceived a child.DesignCross-sectional study.MethodsSix males aged 19-48 years were included. Gonadotropins, testosterone, DHEAS, androstenedione, inhibin B, anti-Mullerian hormone measurements and testicular ultrasound were performed.ResultsAll six male patients had impaired general health and neurological symptoms including erectile and ejaculatory dysfunction. None of them had an offspring. The only demonstrated cause of infertility in our male patients was erectile and ejaculatory dysfunction which precludes sexual intercourse. Our patients had normal libido but were sexually abstinent. Except for low adrenal androgen levels, the concentrations of all measured hormones as well as testicular ultrasound were normal which may indicate the possibility of spermatogenesis in male patients with triple A syndrome. Little is known about fertility in female patients, but based on our observations spontaneous pregnancies seem to be possible.ConclusionOur results contribute to still scarce knowledge on fertility in patients with Triple A syndrome and as well represents a foundation for further research on causes of infertility and possible treatment options.

This article - Recommendations and Guidelines of Integrative Medicine (IM) for COVID-19 Care - was one of the outcomes from an Asia-Pacific Economic Cooperation (APEC) Project (Integrative Medicine (IM) and COVID -19 Care) during the time between May 2022 and March 2023. With the efforts from care providers, researchers, health policy makers and healthcare administrative leaders among APEC economies, the purpose of this file was to provide comprehensive IM systems for COVID-19 care as recommendations and suggestive guidelines including care methods, tools, procedures, symptom conditions and targets selections, and points need to be considered during care applications. All cited COVID-19 care practices have confirmed their efficacy and usefulness either used alone or combined with conventional medicine. This article provides current useful medical information on IM for COVID-19 care which could benefit APEC economies and world health communities on their healthcare system.

Realistic representation of monthly sea level anomalies in coastal regions has been a challenge for global ocean reanalyses. This is especially the case in coastal regions where sea levels are influenced by western boundary currents such as near the U.S. Atlantic Coast and the Gulf of Mexico. For these regions, most ocean reanalyses compare poorly to observations. Problems in reanalyses include errors in data assimilation and horizontal resolutions that are too coarse to simulate energetic currents like the Gulf Stream and Loop Current System. However, model capabilities are advancing with improved data assimilation and higher resolution. Here, we show that some current-generation ocean reanalyses produce monthly sea level anomalies with improved skill when compared to satellite altimetry observations of sea surface heights. Using tide gauge observations for coastal verification, we find the highest skill associated with the GLORYS12 and HYCOM ocean reanalyses. Both systems assimilate altimetry observations and have eddy-resolving horizontal resolutions (1/12°). We found less skill in three other ocean reanalyses (ACCESS-S2, ORAS5, and ORAP6) with coarser, though still eddy-permitting, resolutions (1/4°). The operational reanalysis from ECMWF (ORAS5) and their pilot reanalysis (ORAP6) provide an interesting comparison because the latter assimilates altimetry globally and with more weight, as well as assimilating ocean observations over continental shelves. We find these attributes associated with improved skill near many tide gauges. We also assessed an older reanalysis (CFSR), which has the lowest skill likely due to its lower resolution (1/2°) and lack of altimetry assimilation. ACCESS-S2 likewise does not assimilate altimetry, although its skill is much better than CFSR and only somewhat lower than ORAS5. Since coastal flooding is influenced by sea level anomalies, the recent development of skilful ocean reanalyses on monthly timescales may be useful for better understanding the physical processes associated with flood risks.

Abstract Rabbit hemorrhagic disease virus 2 (RHDV2), recently detected in the western United States, has the potential to cause mass mortality events in wild rabbit and hare populations. Currently, few management strategies exist other than vaccination. We developed a spatially explicit model of RHDV2 for a population of riparian brush rabbits (Sylvilagus bachmani riparius), a subspecies of brush rabbit classified as endangered in the United States, on a subsection of the San Joaquin River National Wildlife Refuge. The goal of our model was to provide guidance regarding vaccination strategies for an endangered rabbit species. Our model predicts that increased interactions between rabbits (a proxy for landscape connectivity) and disease transmission rates among susceptible hosts (individual brush rabbits and conspecifics) have the greatest influence on the outcome of a potential vaccination campaign. Our model projects that across a range of parameter estimates (given an RHDV2 incursion), the median estimated population size with a 0%–10% vaccination rate after 1 year is 538 rabbits (95% Confidence Interval [C.I.] 69–1235), approximately 36% of the expected size of the study population of 1470 rabbits without an RHDV2 introduction. With a 10%–20%, 20%–30%, or 30%–40% vaccination rate, the median estimated population size increased to 628 rabbits (95% C.I. 130–1298), 723 rabbits (95% C.I. 198–1317), and 774 rabbits (95% C.I. 228–1410), respectively. These estimates represent 43%, 49%, and 53% of the expected population size without an RHDV2 introduction. Overall, a 1% increase in vaccination rate was associated with a six rabbit (95% C.I. 5–7) increase in total remaining population size. This result is dependent on assumptions regarding environmental transmission, home range size (and contact rates of rabbits). Given the relatively short lifespan of rabbits and the potential need for boosters, vaccination programs are most likely to be successful for small target populations where relatively high vaccination rates can be maintained.

Este estudo tem por objetivo discutir a inexistência de modelo jurídico brasileiro que seja capaz de pautar os negócios sociais. Os negócios sociais possuem um alto potencial de gerar transformações na sociedade, enquanto geram resultados financeiros positivos. O ecossistema de negócio social no Brasil cresceu significativamente nos últimos anos, contudo no Brasil não há uma legislação específica para regulamentar os negócios sociais, inclusive no plano societário, gerando uma lacuna na constituição societária para formalização desses empreendimentos, os quais tem se dado por meio da adoção dos diversos tipos de pessoas jurídicas existentes, ora próprios do segundo setor, por meio da sociedade com responsabilidade limitada ou anônima, ora próprios do terceiro setor, normalmente por meio de associações. A pesquisa proposta foi desenvolvida a partir de uma revisão bibliográfica consistindo na análise de uma vasta produção teórica em diferentes bases de artigos e livros científicos. Como resultados, foi possível observar que os formatos legais possíveis para os negócios de impacto no Brasil são variados, podendo haver ou não distribuição de dividendos ou até mesmo retorno de capital aplicado aos investidores, dependendo do formato legal escolhido. Reconhece que o empreendedorismo social, a depender do país, possui contornos e formatos jurídicos distintos. Conclui-se que dentre as contribuições deste estudo, destaca-se que um tipo jurídico específico deve ser criado para esse tipo de negócio, de modo a trazer mais segurança jurídica aos envolvidos, uma vez que o tema se encontra crescente no país.

BackgroundCauda equina syndrome (CES) is a lumbosacral surgical emergency that has been associated with chiropractic spinal manipulation (CSM) in case reports. However, identifying if there is a potential causal effect is complicated by the heightened incidence of CES among those with low back pain (LBP). The study hypothesis was that there would be no increase in the risk of CES in adults with LBP following CSM compared to a propensity-matched cohort following physical therapy (PT) evaluation without spinal manipulation over a three-month follow-up period.MethodsA query of a United States network (TriNetX, Inc.) was conducted, searching health records of more than 107 million patients attending academic health centers, yielding data ranging from 20 years prior to the search date (July 30, 2023). Patients aged 18 or older with LBP were included, excluding those with pre-existing CES, incontinence, or serious pathology that may cause CES. Patients were divided into two cohorts: (1) LBP patients receiving CSM or (2) LBP patients receiving PT evaluation without spinal manipulation. Propensity score matching controlled for confounding variables associated with CES.Results67,220 patients per cohort (mean age 51 years) remained after propensity matching. CES incidence was 0.07% (95% confidence intervals [CI]: 0.05-0.09%) in the CSM cohort compared to 0.11% (95% CI: 0.09-0.14%) in the PT evaluation cohort, yielding a risk ratio and 95% CI of 0.60 (0.42-0.86; p = .0052). Both cohorts showed a higher rate of CES during the first two weeks of follow-up.ConclusionsThese findings suggest that CSM is not a risk factor for CES. Considering prior epidemiologic evidence, patients with LBP may have an elevated risk of CES independent of treatment. These findings warrant further corroboration. In the meantime, clinicians should be vigilant to identify LBP patients with CES and promptly refer them for surgical evaluation.

Aim. Retrospective national sub-analysis of antidiabetic pharmacotherapy in patients with diabetes mellitus (DM) and heart failure (HF) based on data reported to the National Register of Paid Health Services in the Czech Republic between 2012-2018. Methodology and Results. In 2012, there were 75,022 patients with HF and DM (i.e. 42.5% of patients with HF), 6 years later 117,265 (i.e. 41.0% of HF patients in 2018). The most represented antidiabetic drug was metformin (45.6%). Of the insulins and analogues, glargine showed the largest positive trend (5.8% 2012; 14.8% 2018). Empagliflozin was the most prescribed SGLT-2 inhibitor (1.8% in 2018). A decrease in prescribing was observed for saxagliptin (0.5% 2012; 0.1% 2018) and for sulfonylurea derivates - gliclazide (13.0% 2012; 10.3% in 2018) and glimepiride (12.9% 2012; 9.0% 2018). Linagliptin was the most prescribed dipeptidyl peptidase inhibitor (0.7% 2012; 6.8% 2018). Conclusion. In the Czech Republic, between 2012 and 2008, there was an increase in prevalence of patients with heart failure and concomitant diabetes mellitus, their proportion being similar. In correspondence with other registries, metformin was used mostly. A positive trend was observed in prescription of DDP-4 and SGLT-2 inhibitors, while there was a significant decrease in patients taking sulfonylureas.

In this paper, the design and research of a sensor-based personal air-quality monitoring device are presented, which is retrofitted into different personal protective face masks. Due to its small size and low power consumption, the device can be integrated into and applied in practical urban usage. We present our research and the development of the sensor node based on a BME680-type environmental sensor cluster with a wireless IoT (Internet of Things)-capable central unit and overall low power consumption. The integration of the sensor node was investigated with traditional medical masks and a professional FFP2-type mask. The filtering efficiency after embedding was validated with a head model and a particle counter. We found that the professional mask withstood the embedding without losing the protective filtering aspect. We compared the inner and outer sensor data and investigated the temperature, pressure, humidity, and AQI (Air Quality Index) relations with possible sensor data-fusion options. The novelty is increased with the dual-sensor layout (inward and outward). It was found that efficient respiration monitoring is achievable with the device. With the analysis of the recorded data, characteristic signals were identified in an urban environment, enabling urban altimetry and urban zone detection. The results promote smart city concepts and help in endeavors related to SDGs (Sustainable Development Goals) 3 and 11.

In this study, the effects of nonstandard near-eutectic SnAg surfaces on the wettability, intermetallic compound growth and mechanical properties of solder joints were investigated. Four types of surface finishes based on near-eutectic SnAg alloys with different compositions and numbers of layers were analyzed. Design/methodology/approach: The effect of surface-finishes SnAg5NiP and SnAg7NiP, which were prepared with and without a Ni-P diffusion barrier, was tested. The Ni-P layer was produced either chemically or electrochemically. The effect of the SnAg surface finish on wettability, formation, and growth of intermetallic compound in the solder joint was analyzed. We further explored the impact of different PCB finishes on the quality of soldered joints. This investigation involved a comparative analysis of the behavior of SnAg finishes in comparison to pure copper, as well as the commonly employed HASL, ENIG, and ImSn finishes. Findings: It was found that SnAg surface finishes with a Ni-P diffusion barrier are wetted by molten solder faster than surface finishes without a diffusion barrier. The mechanical properties of the joints on both surfaces are comparable to those on ENIG. SnAg that include a chemically created Ni-P diffusion layer is characterized by the formation of more thermally stable ternary intermetallic compounds based on (Cu,Ni)6Sn5 and (Ni,Cu)3Sn4. On the contrary, the electrochemically formed Ni layer supports the increase in the rate of intermetallic compound formation, which affects the properties of the soldered joints. Originality: Nonstandard near-eutectic SnAg finishes, which contains a Ni-P diffusion layer can be used as promising replacement of ENIG or other standard finishes.

Abstract Background This review aimed to identify variables influencing clinicians’ application of spinal manipulative therapy (SMT) for persistent spine pain after lumbar surgery (PSPS-2). We hypothesized markers of reduced clinical/surgical complexity would be associated with greater odds of applying SMT to the lumbar region, use of manual-thrust lumbar SMT, and SMT within 1-year post-surgery as primary outcomes; and chiropractors would have increased odds of using lumbar manual-thrust-SMT compared to other practitioners. Methods Per our published protocol, observational studies describing adults receiving SMT for PSPS-2 were included. PubMed, Web of Science, Scopus, OVID, PEDro, and Index to Chiropractic Literature were searched from inception to January 6, 2022. Individual patient data (IPD) were requested from contact authors when needed for selection criteria. Data extraction and a customized risk-of-bias rubric were completed in duplicate. Odds ratios (ORs) for primary outcomes were calculated using binary logistic regressions, with covariates including age, sex, symptom distribution, provider, motion segments, spinal implant, and surgery-to-SMT interval. Results 71 articles were included describing 103 patients (mean age 52 ± 15, 55% male). The most common surgeries were laminectomy (40%), fusion (34%), and discectomy (29%). Lumbar SMT was used in 85% of patients; and of these patients was non-manual-thrust in 59%, manual-thrust in 33%, and unclear in 8%. Clinicians were most often chiropractors (68%). SMT was used > 1-year post-surgery in 66% of cases. While no primary outcomes reached significance, non-reduced motion segments approached significance for predicting use of lumbar-manual-thrust SMT (OR 9.07 [0.97–84.64], P = 0.053). Chiropractors were significantly more likely to use lumbar-manual-thrust SMT (OR 32.26 [3.17–327.98], P = 0.003). A sensitivity analysis omitting high risk-of-bias cases (missing ≥ 25% IPD) revealed similar results. Conclusions Clinicians using SMT for PSPS-2 most often apply non-manual-thrust SMT to the lumbar spine, while chiropractors are more likely to use lumbar-manual-thrust SMT relative to other providers. As non-manual-thrust SMT may be gentler, the proclivity towards this technique suggests providers are cautious when applying SMT after lumbar surgery. Unmeasured variables such as patient or clinician preferences, or limited sample size may have influenced our findings. Large observational studies and/or international surveys are needed for an improved understanding of SMT use for PSPS-2. Systematic review registration PROSPERO (CRD42021250039).

Abstract Imprecise vowels represent a common deficit associated with hypokinetic dysarthria resulting from a reduced articulatory range of motion in Parkinson’s disease (PD). It is not yet unknown whether the vowel articulation impairment is already evident in the prodromal stages of synucleinopathy. We aimed to assess whether vowel articulation abnormalities are present in isolated rapid eye movement sleep behaviour disorder (iRBD) and early-stage PD. A total of 180 male participants, including 60 iRBD, 60 de-novo PD and 60 age-matched healthy controls performed reading of a standardized passage. The first and second formant frequencies of the corner vowels /a/, /i/, and /u/ extracted from predefined words, were utilized to construct articulatory-acoustic measures of Vowel Space Area (VSA) and Vowel Articulation Index (VAI). Compared to controls, VSA was smaller in both iRBD (p = 0.01) and PD (p = 0.001) while VAI was lower only in PD (p = 0.002). iRBD subgroup with abnormal olfactory function had smaller VSA compared to iRBD subgroup with preserved olfactory function (p = 0.02). In PD patients, the extent of bradykinesia and rigidity correlated with VSA (r = −0.33, p = 0.01), while no correlation between axial gait symptoms or tremor and vowel articulation was detected. Vowel articulation impairment represents an early prodromal symptom in the disease process of synucleinopathy. Acoustic assessment of vowel articulation may provide a surrogate marker of synucleinopathy in scenarios where a single robust feature to monitor the dysarthria progression is needed.

Abstract Background While most cases of sciatica result from degenerative conditions of the low back, some cases result from conditions of the hip and pelvic region. Sciatica developing in relation to pregnancy or labor also presents unique considerations. Case presentation A 37-year-old African American woman with a history of hypertension and polycystic ovary syndrome presented to a chiropractor at a hospital-based outpatient clinic with a seven-week history of low back pain with radiation into the right lower extremity which began during labor. The chiropractor performed a brief trial of care, yet when the patient’s symptoms worsened, ordered lumbar spine radiographs, followed by lumbar magnetic resonance imaging (MRI), which were both normal. The chiropractor then ordered hip radiographs, which were suggestive of ischial osteochondroma, and referred the patient to an orthopedic oncologist. MRI findings were compatible with an osteochondroma with associated adventitial bursitis and mass effect on the sciatic nerve. The patient initially chose conservative management with bursa aspiration and therapeutic injection. Despite initial relief, there was eventual return of symptoms. The patient elected to undergo surgical removal, with a positive outcome. Conclusion The key distinguishing features that led to a diagnosis of osteochondroma in this case included attention to the patient-reported symptoms and history, worsening of symptoms despite conservative care, and lack of explanatory findings on lumbar imaging. This case highlights the benefit of evaluating the hip and pelvis when the clinical features of sciatica cannot be ascribed to a lumbar etiology. This case also illustrates the role of a chiropractor working in an integrative health system to facilitate timely imaging and referrals to resolve a challenging diagnosis.