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Abstract Background Malnutrition in the elderly places a significant burden on healthcare, social, and aged-care systems, yet it often remains undiagnosed and untreated. This study aims to evaluate family physicians' knowledge and attitudes towards the diagnosis and treatment of malnutrition in the elderly. Methods Based on a literature review, an online questionnaire was developed, comprised of seven knowledge-related items and eight attitude-related questions regarding malnutrition in elderly populations. We also assessed the feasibility of including two malnutrition screening questions in regular clinic visits for individuals aged ≥ 70 years. Results Surveys were completed by 126 physicians (35% response rate), mean age 47.2 ± 12.6 years; 15.6 ± 12.5 years of practice; 67% females; and 92% board-certified family physicians. Moreover, 77.6% agreed that diagnosing malnutrition is important in patients with decreased appetite. Most respondents demonstrated knowledge of nutritional screening principles (63.5%) and recognized that even obese elderly individuals could be malnourished (83.2%). There was partial agreement (60%) that normal BMI values in the elderly differ from those in younger populations. Almost complete agreement was seen for incorporating two nutritional status questions in medical visits (91%), with physicians expressing willingness to receive training in malnutrition identification and screening tools. Despite challenges such as time constraints and limited knowledge, participants were open to conducting biannual malnutrition risk screening for elderly patients. Conclusion We recommend malnutrition screening in primary care followed by malnutrition diagnosis and referral of malnourished patients to the proper intervention.

Abstract Culture-adapted human mesenchymal stromal cells (hMSCs) are appealing candidates for regenerative medicine applications. However, these cells implanted in lesions as single cells or tissue constructs encounter an ischemic microenvironment responsible for their massive death post-transplantation, a major roadblock to successful clinical therapies. We hereby propose a paradigm shift for enhancing hMSC survival by designing, developing, and testing an enzyme-controlled, nutritive hydrogel with an inbuilt glucose delivery system for the first time. This hydrogel, composed of fibrin, starch (a polymer of glucose), and amyloglucosidase (AMG, an enzyme that hydrolyze glucose from starch), provides physiological glucose levels to fuel hMSCs via glycolysis. hMSCs loaded in these hydrogels and exposed to near anoxia (0.1% pO2) in vitro exhibited improved cell viability and angioinductive functions for up to 14 days. Most importantly, these nutritive hydrogels promoted hMSC viability and paracrine functions when implanted ectopically. Our findings suggest that local glucose delivery via the proposed nutritive hydrogel can be an efficient approach to improve hMSC-based therapeutic efficacy.

Abstract Background Binge-eating disorder) BED) is the most common eating disorder in the United-States. Daily, orally administered topiramate has shown BED treatment efficacy, with two major limitations: frequent and severe side effects and slow time-to-effect. SipNose is a novel non-invasive intranasal direct nose-to-brain drug delivery platform that delivers drugs to the central nervous system consistently and rapidly. Herein, we study a SipNose-topiramate combination product, as an acute “as needed” (PRN) solution for BED management. Methods First, SipNose-topiramate’s pharmacokinetics (PK) and safety was evaluated. The second part aimed to demonstrate its PRN-treatment feasibility in terms of usability and potential efficacy in reducing the number of binge-eating events. Twelve BED patients were studied over three time periods; 2-weeks of baseline monitoring [BL], 8-weeks of treatment [TX], and 2-weeks of follow up [FU]. Results The PK profile showed peak plasma levels at 90 min post-administration, a t1/2 > 24 h and consistent topiramate delivery with no adverse events. In the second part, 251 treatments were self-administered by the patient participants. There was a significant reduction from baseline to treatment periods in mean weekly binge-eating events and binge-eating event days per week. This was maintained during the follow up period. Efficacy was corroborated by improved patient illness severity scales. There were no adverse events associated with any administered treatments. Patients were exposed to less drug when compared with accepted oral dosing. Conclusions This study introduces a SipNose-topiramate drug-device combination as a potentially safe, effective, and controlled method for BED management. Its findings introduce a potential approach to BED management both as an intranasal and as a PRN therapy for reducing binge-eating events, with a large-scale reduction in patient drug exposure and side effects and with improved patient quality of life. Further studies are needed with larger patient populations to establish SipNose-topiramate as a mainstream treatment for BED. Trial registration: Registration number and date of registration of the clinical studies reported in this article are as follows: 0157-18-HMO, August 15th 2018 and 6814-20-SMC, December 2nd 2020.

Current literature lacks structured methodologies for analyzing medical technologies’ impact from the patient-centered care perspective. This study introduces, applies and validates ‘Patient-Centered Care Impact Analysis’ (PCIA) as a method for identifying patient-centered care associated demands and expectations for a particular technology and assessing its compliance with these demands. PCIA involves five stages: (1) demand identification, (2) ranking demands’ impact magnitude, (3) scoring demand compliance (DC), (4) demand priority (DP) assignment based on impact magnitude and compliance, (5) generating a summative impact priority number (IPN). PCIA was performed as a comparative assessment of two central nervous system (CNS) drug-delivery platforms; SipNose, a novel noninvasive Direct-Nose-to-Brain (DNTB), vs. the standard-of-care invasive intrathecal/intracerebroventricular injection (Invasive I/I). Study participants included a ranking team (RT) without experience with the SipNose technology that based their scoring on experimental data; and a validation team (VT) experienced with the SipNose platform. All had experience with, or knowledge of, InvasiveI/I. Demand identification and impact magnitude were performed by one content and one assessment expert. Each participant assessed each technology’s DC. DP scores, IPN’s and IPN DNTB:InvasiveI/I ratios were generated for each technology, for each team, based on DC and summative DP scores, respectively. Both teams assigned DNTB higher DC scores, resulting in higher DNTB DP, IPN scores and DNTB:InvasiveI/I IPN ratios. Lack of difference between team assessments of DP and IPN ratio validate PCIA as an assessment tool capable of predicting patient-centered clinical care quality for a new technology. The significant differences between the platforms highlight SipNose’s patient-care centered advantages as an effective CNS drug-delivery platform.

Abstract Over the last two decades, variable‐speed wind turbines (VSWTs) have gradually replaced conventional generation. However, the variable and stochastic nature of wind speed may lead to large frequency deviations, especially in isolated power systems with high wind energy integration, where this integration causes a lack of inertia. This paper proposes a hybrid hydro‐wind‐flywheel frequency control strategy for isolated power systems with 100% renewable energy generation, considering both variable wind and a generator tripping. VSWTs and flywheels include a conventional inertial frequency control. The frequency control strategy involves VSWTs rotational speed and State of Charge (SOC) of flywheels variations that may affect the wear and tear of mechanical elements and reduce the efficiency of the frequency control action. The hydro‐power controller also tracks the VSWTs' rotational speed deviation and the flywheel SOC to modify the generated power accordingly. This hybrid frequency strategy significantly reduces frequency excursions, the rotational speed deviations of VSWTs and the SOC of flywheels. To reduce the hydro‐power plants' wear, an additional control strategy is proposed by the authors and evaluated. Results from a case study based on an isolated power system located in El Hierro (Canary Islands, Spain) are included, and extensively discussed in the paper.

The efficient use of the photovoltaic power requires a good estimation of the PV generation. That is why the use of good techniques for forecast is necessary. In this research paper, Long Short-Term Memory, Bidirectional Long Short-Term Memory and the Temporal convolutional network are studied in depth to forecast the photovoltaic power, voltage and efficiency of a 1320 Wp amorphous plant installed in the Technology Support Centre in the University Rey Juan Carlos, Madrid (Spain). The accuracy of these techniques are compared using experimental data along one year, applying 1 timestep or 15 min and 96 step times or 24 h, showing that TCN exhibits outstanding performance, compared with the two other techniques. For instance, it presents better results in all forecast variables and both forecast horizons, achieving an overall Mean Squared Error (MSE) of 0.0024 for 15 min forecasts and 0.0058 for 24 h forecasts. In addition, the sensitivity analyses for the TCN technique is performed and shows that the accuracy is reduced as the forecast horizon increases and that the 6 months of dataset is sufficient to obtain an adequate result with an MSE value of 0.0080 and a coefficient of determination of 0.90 in the worst scenarios (24 h of forecast).

Increased renewable energy penetration in isolated power systems has a clear impact on the quality of system frequency. The flywheel energy storage system (FESS) is a mature technology with a fast frequency response, high power density, high round-trip efficiency, low maintenance, no depth of discharge effects, and resilience to withstand continuous charge-discharge cycling without lifetime degradation. These FESS properties allows to effectively address the frequency quality problem. This study analyzes the contribution of a FESS to reducing frequency deviations in an isolated system that combines a diesel plant, wind farm, and pump-storage hydropower plant based on the El Hierro power system. This study approaches this analysis by comparing six different FESS governor control schemes (GCSs). Of these six GCSs, the nonlinear proportional variant (NLP $_{\mathrm {V}}$ ) is a singular contribution based on the NLP scheme previously developed by the same researchers. Different governor’s parameter settings for the FESS GCSs were also compared, obtained from the proposed tuning methodology that considers the renewable energy generation distribution, frequency impact, and lifetime degradation of diesel, hydraulic groups, and flywheels. The GCSs were compared in terms of average frequency deviation, Zenith and Nadir frequency difference, wear and tear of diesel electromechanical elements and Pelton turbine nozzles, flywheels cycles per hour, and FESS average state of charge. The results show that including a FESS plant considerably improves frequency regulation. The tuning criteria and GCSs have a clear influence on the results, with NLP and NLPV GCSs offering relevant improvements in frequency deviations.

BackgroundDespite calls for interprofessional teamwork to ensure quality care in healthcare settings, interprofessional teams do not always perform effectively. There is evidence that professional stereotypes inhibit effective interprofessional teamwork, but they haven’t been explored as a phenomenon that impacts team’s performance and quality of care.ObjectivesTo focus on professional stereotypes emerging in interprofessional teams and examine the contingency effects of interprofessional team’s faultlines, professional stereotypes, and leader’s championship behaviors on team’s quality of care.MethodsA cross-sectional nested sample of 59 interprofessional teams and 284 professionals, working in geriatric long-term-care facilities in Israel. Additionally, five to seven of the residents of each facility were randomly sampled to obtain the outcome variable. Data collection employed a multisource (interprofessional team members), multimethod (validated questionnaires and data from residents’ health records) strategy.ResultsThe results indicated that faultlines are not directly harmful to team’s quality of care; instead, they are likely to impact quality of care only when team stereotypes emerge. Furthermore, whereas teams typified by high professional stereotypes require person-oriented championship leadership, for teams typified by low team stereotypes, championship leadership harms the quality of care they provide.ConclusionThese findings have implications for handling interprofessional teams. Practically, leaders must be well-educated to better analyze team members’ needs and maintain the appropriate leadership style.

Abstract Opto-mechanical interactions in guided wave media are drawing great interest in fundamental research and applications. Forward stimulated Brillouin scattering, in particular, is widely investigated in optical fibres and photonic integrated circuits. In this work, we report a comprehensive study of forward stimulated Brillouin scattering over standard, panda-type polarization maintaining fibres. We distinguish between intra-polarization scattering, in which two pump tones are co-polarized along one principal axis, and inter-polarization processes driven by orthogonally polarized pump waves. Both processes are quantified in analysis, calculations and experiment. Inter-modal scattering, in particular, introduces cross-polarization switching of probe waves that is non-reciprocal. Switching takes place in multiple wavelength windows. The results provide a first demonstration of opto-mechanical non-reciprocity of forward scatter in standard fibre. The inter-polarization process is applicable to distributed sensors of media outside the cladding and coating boundaries, where light cannot reach. The process may be scaled towards forward Brillouin lasers, optical isolators and circulators and narrowband microwave-photonic filters over longer sections of off-the-shelf polarization maintaining fibres.

Summary: Background: The current SARS-CoV-2 pandemic created an urgent need for rapid, infection screening applied to large numbers of asymptomatic individuals. To date, nasal/throat swab polymerase chain reaction (PCR) is considered the “gold standard”. However, this is inconducive to mass, point-of-care (POC) testing due to person discomfort during sampling and a prolonged result turnaround. Breath testing for disease specific organic compounds potentially offers a practical, rapid, non-invasive, POC solution. The study compares the Breath of Health, Ltd. (BOH) breath analysis system to PCR's ability to screen asymptomatic individuals for SARS-CoV-2 infection. The BOH system is mobile and combines Fourier-transform infrared (FTIR) spectroscopy with artificial intelligence (AI) to generate results within 2 min and 15 s. In contrast to prior SARS-CoV-2 breath analysis research, this study focuses on diagnosing SARS-CoV-2 via disease specific spectrometric profiles rather than through identifying the disease specific molecules. Methods: Asymptomatic emergency room patients with suspected SARS-CoV-2 exposure in two leading Israeli hospitals were selected between February through April 2021. All were tested via nasal/throat-swab PCR and BOH breath analysis. In total, 297 patients were sampled (mean age 57·08 ± SD 18·86, 156 males, 139 females, 2 unknowns). Of these, 96 were PCR-positive (44 males, 50 females, 2 unknowns), 201 were PCR-negative (112 males, 89 females). One hundred samples were used for AI identification of SARS-CoV-2 distinguishing spectroscopic wave-number patterns and diagnostic algorithm creation. Algorithm validation was tested in 100 proof-of-concept samples (34 PCR-positive, 66 PCR-negative) by comparing PCR with AI algorithm-based breath-test results determined by a blinded medical expert. One hundred additional samples (12 true PCR-positive, 85 true PCR-negative, 3 confounder false PCR-positive [not included in the 297 total samples]) were evaluated by two blinded medical experts for further algorithm validation and inter-expert correlation. Findings: The BOH system identified three distinguishing wave numbers for SARS-CoV-2 infection. In the first phase, the single expert identified the first 100 samples correctly, yielding a 1:1 FTIR/AI:PCR correlation. The two-expert second-phase also yielded 1:1 FTIR/AI:PCR correlation for 97 non-confounders and null correlation for the 3 confounders. Inter-expert correlation was 1:1 for all results. In total, the FTIR/AI algorithm demonstrated 100% sensitivity and specificity for SARS-CoV-2 detection when compared with PCR. Interpretation: The SARS-CoV-2 method of breath analysis via FTIR with AI-based algorithm demonstrated high PCR correlation in screening for asymptomatic individuals. This is the first practical, rapid, POC breath analysis solution with such high PCR correlation in asymptomatic individuals. Further validation is required with a larger sample size. Funding: Breath of Health Ltd, Rehovot, Israel provided study funding.

(1) Background: This paper examines the elements essential to effective teacher professional development (TPD) and the relationship between various professional environmental factors (professional learning community perceptions, self-efficacy, professional identity, principal’s transformation leadership patterns), TDP in primary education schools, and TDP prediction. (2) Methods: Data were collected during the 2020 school year from 412 teachers in primary education schools in five Israeli districts. The professional learning community, self-efficacy, professional identity, transformation leadership patterns, and TPD scales were used to collect data. Descriptive statistics, Pearson moment-product correlation, and multiple regression analysis were used for data analysis. (3) Results: Overall, participants’ TPD was high (4.12 ± 0.83). Statistically significant correlations were observed between TPD and four independent variables (0.41–0.64; p < 0.0001). No significant associations were seen between TPD and work-related characteristics. TPD differences were observed in participants with different educational levels (F = 4.63; p = 0.003). Higher TPD levels were predicted by perceptions of the principal’s transformation leadership patterns, self-efficacy, the professional learning community, and education (F-ratio = 57.85; adjusted R2 = 0.50; p < 0.001). Conclusions: The present study attests to the importance of the school principal’s leadership patterns for TPD, alongside the contribution of self-efficacy, professional learning community, and professional identity.

Distributed fibre sensors are so far restricted to the monitoring of conditions within the core. Here, Bashan et al. introduce distributed optomechanical mapping of outside media, where light cannot reach. The sensor resolves forward stimulated Brillouin scattering through Rayleigh back-scatter.

This study aimed to evaluate the potential adverse effects of the dermal administration of Dillenia indica Linnaeus (D. indica) fruit extract in healthy rodents; the extract was standardized to betulinic acid. In the initial phase, the acute effects were evaluated on the skin application site of a single extract dose. A skin irritation test was performed in male Wistar rats (n = 8/group) receiving the extract (50-150 mg/mL) with betulinic acid (0.5-1.5%, respectively). A photosensitivity test was performed in male BALB/c mice (n = 6/group) receiving the extract (150 mg/mL). Afterwards, other BALB/c mice (n = 20, male:female, 1:1) were used to assess the systemic alterations caused by 14 daily repeated doses (150 mg/mL) by monitoring the effects on mortality, body morphology, behavior, nutrition status, neuromotor reactions, organ morphology and weight, and blood tests. At this time, 0.5 mg/mL clobetasol was used as the positive control. The skin irritation index suggested that negligible skin irritation had occurred, even when the extract was applied to the rat skin at 150 mg/mL. However, the extract acted as a photosensitizer on mouse skin, showing a photosensitizing activity close to that of 10 mg/mL 5-methoxypsoralen. Repeated doses caused no mouse mortality, aggressiveness, piloerection, diarrhea, convulsions, neuromotor alterations or nutrition status changes. The mouse organ weights did not change, and the mice did not have alterations in their blood compositions. Clobetasol caused a reduction in the mononuclear leukocyte numbers. In general, the data suggest that the extract was safe in healthy rodents but indicate that caution should be taken with the photosensitizing activity; in addition, this activity should be further explored as it may be useful for phototherapeutic drug development.

The analysis of surrounding media has been a long-standing challenge of optical fiber sensors. Measurements are difficult due to the confinement of light to the inner core of standard fibers. Over the last two years, new sensor concepts have enabled the analysis of liquids outside the cladding boundary, where light does not reach. Sensing is based on opto-mechanical, forward stimulated Brillouin scattering (F-SBS) interactions between guided light and sound waves. In most previous studies, however, the protective polymer coating of the fiber had to be removed first. In this work, we report the opto-mechanical analysis of liquids outside commercially available, standard single-mode fibers with polyimide coating. The polyimide layer provides mechanical protection but can also transmit acoustic waves from the fiber cladding toward outside media. The comprehensive analysis of opto-mechanical coupling in coated fibers that are immersed in liquid is provided. The model shows that F-SBS spectra in coated fibers are more complex than those of bare fibers and strongly depend on the exact coating diameter and the choice of acoustic mode. Nevertheless, sensing outside coated fibers is demonstrated experimentally. Integrated measurements over 100 m of fiber clearly distinguish between air, ethanol, and water outside polyimide coating. Measured spectra are in close quantitative agreement with the analytic predictions. Furthermore, distributed opto-mechanical time-domain reflectometry mapping of water and ethanol outside coated fiber is reported, with a spatial resolution of 100 m. The results represent a large step toward practical opto-mechanical fiber sensors.

In this study, we aim to explore the outcomes of Covid‐19 infection in patients with Hairy cell leukemia (HCL). The cohort is based on data obtained from electronic medical records. It includes 218 consecutive patients diagnosed with HCL between 16 June 1998, and 20 September 2022, out of which the coronavirus has infected 85 patients during the Omicron surge. Out of 85 patients with HCL who were infected by Covid‐19; 7 patients (8.2%) have been hospitalized, and the mortality rate was 2.3% (two patients). Thirteen of the 85 patients had been infected by Covid‐19 in previous waves, including 9/13 after vaccination, and none of them developed a severe disease. Humoral immune response after three doses of the BNT162b2 mRNA vaccination regimen was evaluated in 40 patients and was attained in 67.5%. Based on multivariate analysis: unfavorable outcome was significantly more common in patients with HCL above 65 years old, who had at least one cytopenia, and with comorbidity of cardiovascular disease or asplenia. Our results indicates that the course of COVID‐19 in patients with HCL during the Omicron wave has been improved relatively favorable. [ABSTRACT FROM AUTHOR]

Background SUMOylation involves the attachment of small ubiquitin-like modifier (SUMO) proteins to specific lysine residues on thousands of substrates with target-specific effects on protein function. Sentrinspecific proteases (SENPs) are proteins involved in the maturation and deconjugation of SUMO. Specifically, SENP7 is responsible for processing polySUMO chains on targeted substrates including the heterochromatin protein 1α (HP1α). Methods We performed exome sequencing and segregation studies in a family with several infants presenting with an unidentified syndrome. RNA and protein expression studies were performed in fibroblasts available from one subject. Results We identified a kindred with four affected subjects presenting with a spectrum of findings including congenital arthrogryposis, no achievement of developmental milestones, early respiratory failure, neutropenia and recurrent infections. All died within fourmonths after birth. Exome sequencing identified a homozygous stop gain variant in SENP7 c.1474C>T; p.(Gln492*) as the probable aetiology. The proband’s fibroblasts demonstrated decreased mRNA expression. Protein expression studies showed significant protein dysregulation in total cell lysates and in the chromatin fraction. We found that HP1α levels as well as different histones and H3K9me3 were reduced in patient fibroblasts. These results support previous studies showing interaction between SENP7 and HP1α, and suggest loss of SENP7 leads to reduced heterochromatin condensation and subsequent aberrant gene expression. Conclusion Our results suggest a critical role for SENP7 in nervous system development, haematopoiesis and immune function in humans. [ABSTRACT FROM AUTHOR]

Forward stimulated Brillouin scattering (F-SBS) is a third-order nonlinear-optical mechanism that couples between two co-propagating optical fields and a guided acoustic mode in a common medium. F-SBS gives rise to nonlinear wave mixing along optical fibers, which adds up with four-wave mixing induced by the Kerr effect. In this work, we report the distributed mapping of nonlinear wave mixing processes involving both mechanisms along standard single-mode fiber, in analysis, simulation, and experiment. Measurements are based on a multi-tone, optical time-domain reflectometry setup, which is highly frequency-selective. The results show that F-SBS leads to nonlinear wave mixing processes that are more complex than those that are driven by the Kerr effect alone. The dynamics are strongly dependent on the exact frequency detuning between optical field components. When the detuning is chosen near an F-SBS resonance, the process becomes asymmetric. Power is coupled from an upper-frequency input pump wave to a lower-frequency one, and the amplification of Stokes-wave sidebands is more pronounced than that of anti-Stokes-wave sidebands. The results are applicable to a new class of distributed fiber-optic sensors, based on F-SBS.

Background: The Medical Student Performance Evaluation (MSPE) is a primary source of information used by residency programs in their selection of trainees. The MSPE contains a narrative description of the applicant’s performance during medical school. In 2002, the Association of American Medical Colleges’ guideline for preparation of the MSPE recommended inclusion of a comparative summative assessment of the student’s overall performance relative to his/her peers (final adjective). Objective: We hypothesize that the inclusion of a final adjective in the MSPE affects a reviewer’s assessment of the applicant’s desirability more than the narrative description of performance and designed a study to evaluate this hypothesis. Design: Fifty-six faculty members from the Departments of Pediatrics and Medicine with experience reviewing MSPEs as part of the intern selection process reviewed two pairs of mock MSPE letters. In each pair, the narrative in one letter was superior to that in the other. Two final adjectives describing relative class ranks were created. Each subject was first presented with a pair of letters with mismatched final adjective (study), i.e., the letter with the stronger narrative was presented with the weaker final adjective and vice versa. The subject was then presented with a second pair of letters without final adjectives (control). Subjects ranked the relative desirability of the two applicants in each pair. Results: The proportion of rankings congruent with the strength of the narratives under study and control conditions were compared. Subjects were significantly less likely to rank the applicants congruent with the strength of the narratives when the strength of the final adjectives conflicted with the strength of the narrative; 42.9% of study letters were ranked congruent with the narrative versus 82.1% of controls (p = 0.0001). Conclusion: The MSPE final adjective had a greater impact than the narrative description of performance on the determination of applicant desirability. Abbreviations: MSPE: Medical Student Performance Evaluation; AAMC: Association of American Medical Colleges; BCM: Baylor College of Medicine

Background: Integrated care is essential for improving the management and health outcomes for people with Parkinson's disease (PD); reliable and objective measures of care integration are few. Objective: The aim of this study was to test the psychometric properties of the Rainbow Model of Integrated Care Measurement Tool (RMIC‐MT, provider version) for healthcare professionals involved in PD care. Methods: A cross‐sectional survey was administered online to an international network representing 95 neurology centers across 41 countries and 588 healthcare providers. Exploratory factor analysis with principal axis extraction method was used to assess construct validity. Confirmatory factor analysis was used to evaluate model fit of the RMIC‐MT provider version. Cronbach's alpha was used to assess the internal consistency reliability. Results: Overall, 371 care providers (62% response rate) participated in this study. No item had psychometric sensitivity problems. Nine factors (professional coordination, cultural competence, triple aims outcome, system coordination, clinical coordination, technical competence, community‐centeredness, person‐centeredness, and organizational coordination) with 42 items were determined by exploratory factor analysis. Cronbach's alpha ranged from 0.76 (clinical coordination) to 0.94 (system coordination) and showed significant correlation among all items in the scale (>0.4), indicating good internal consistency reliability. The confirmatory factor analysis model passed most goodness‐of‐fit tests, thereby confirming the factor structure of nine categories with a total of 40 items. Conclusions: The results provide evidence for the construct validity and other psychometric properties of the provider version of the RMIC‐MT to measure integrated care in PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

An opto-electronic radio-frequency oscillator that is based on forward scattering by the guided acoustic modes of a standard single-mode optical fiber is proposed and demonstrated. An optical pump wave is used to stimulate narrowband, resonant guided acoustic modes, which introduce phase modulation to a co-propagating optical probe wave. The phase modulation is converted to an intensity signal at the output of a Sagnac interferometer loop. The intensity waveform is detected, amplified, and driven back to modulate the optical pump. Oscillations are achieved at a frequency of 319 MHz, which matches the resonance of the acoustic mode that provides the largest phase modulation of the probe wave. Oscillations at the frequencies of competing acoustic modes are suppressed by at least 40 dB. The linewidth of the acoustic resonance is sufficiently narrow to provide oscillations at a single longitudinal mode of the hybrid cavity. Competing longitudinal modes are suppressed by at least 38 dB as well. Unlike other opto-electronic oscillators, no radio-frequency filtering is required within the hybrid cavity. The frequency of oscillations is entirely determined by the fiber opto-mechanics.

This study aimed to examine how allied healthcare professionals as informal leaders can lead reforms to improve patient care on an interprofessional team. With 284 interprofessional team members working in 59 geriatric facilities, our findings demonstrated that informal leaders exhibiting more championship behaviors gained higher innovation success scores. In addition, the champion's professional tenure and institutional size were both negatively associated with innovation success. We discuss important implications for this understudied issue in interprofessional team research: how a low-status informal leader can direct reform aimed at improving patient care within a healthcare organization. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic varicose veins, one of the main causes of chronic pelvic pain and dyspareunia, are an important source of reflux for lower limb varicose veins, especially in recurrent cases. Color Doppler ultrasound of the lower limbs and transvaginal ultrasound are the noninvasive diagnostic methods most commonly used to assess pelvic venous insufficiency, whereas phlebography is still considered as the gold standard. Objectives: To determine the prevalence of lower limb varicose veins originating from the pelvis in a group of female patients and to determine the agreement between results obtained via color Doppler ultrasound of the lower limbs, transvaginal ultrasound, and phlebography. Methods: The sample comprised female patients referred to a vascular laboratory for lower limb screening. Patients diagnosed with deep venous thrombosis were excluded. Data analysis included kappa coefficient of agreement, McNemar's test, sensitivity and specificity values. Results: Of a total of 1,020 patients, 124 (12.2%) had findings compatible with reflux of pelvic origin. Among these patients, 51 (41.2%) were recurrent cases. A total of 249 were submitted to transvaginal ultrasound. There was significant agreement between lower limb ultrasonographic findings and transvaginal findings. Phlebography was performed in 54 patients. The comparison between transvaginal ultrasound and phlebography was associated with a 96.2% sensitivity and 100% specificity. Conclusions: The authors draw attention to the relatively high prevalence of lower limb varicose veins originating from the pelvis, suggesting an important but underdiagnosed cause of recurrent varicose veins.Introdução: AS VARIZES Pélvicas, uma das principais causas de dor pélvica crônica e dispareunia, são uma importante fonte de refluxo para as varizes dos membros inferiores, especialmente em casos recorrentes. O Doppler colorido dos membros inferiores e o ultrassom transvaginal são os métodos diagnósticos não-invasivos mais comumente usados para avaliar a insuficiência venosa pélvica, enquanto a flebografia ainda é considerada como o padrão-ouro. Objetivos: Determinar a prevalência de varizes dos membros inferiores originadas na pélvis em um grupo de pacientes do sexo feminino e determinar a concordância entre os resultados obtidos por Doppler colorido dos membros inferiores, ultrassom transvaginal e flebografia. Métodos: A AMOstra incluiu pacientes do sexo feminino encaminhadas para o laboratório vascular para triagem dos membros inferiores. As pacientes diagnosticadas com trombose venosa profunda foram excluídas. A análise dos dados incluiu o coeficiente de concordância kappa, o teste de McNemar e os valores de sensibilidade e especificidade. Resultados: De um total de 1.020 pacientes, 124 (12.2%) tiveram achados compatíveis com refluxo de origem pélvica. Entre essas pacientes, 51 (41.2%) eram casos recorrentes. Um total de 249 foram submetidas a ultrassom transvaginal. Houve concordância significativa entre os achados ultrassonográficos dos membros inferiores e os achados transvaginais. A flebografia foi realizada em 54 pacientes. A comparação entre o ultrassom transvaginal e a flebografia foi associada a 96.2% de sensibilidade e 100% de especificidade. Conclusões: OS AUTores chamam a atenção para a prevalência relativamente alta de varizes dos membros inferiores originadas na pélvis, sugerindo uma importante, embora subdiagnosticada, causa de varizes recorrentes.

A laboratory study was conducted in order to gain an understanding of thermal convection in a complex terrain that is characterized by a plateaued mountain. In particular, the separation of upslope (anabatic) flow over a two-dimensional uniform smooth slope, topped by a plateau, was considered. The working fluid was homogeneous water (neutral stratification). The topographic model was immersed in a large water tank with no mean flow. The entire topographic model was uniformly heated, and the width of the plateau, the slope angle, and the heating rate were varied. The upslope velocity field was measured by the Particle Tracking Velocimetry, aided by Feature Tracking Visualizations in order to detect the flow separation location. An analysis of the resulting flow showed a quantitative similarity to separating the upslope flow over steeper slopes, in the absence of a plateau when an effective angle that incorporates the normalized plateau width, the slope length, and the geometric slope angle, was used. Predictions for the dependence of the separation location and velocity on the geometry and heat flux were presented and compared with the existing data.

Background: Despite calls for interprofessional teamwork to ensure quality care in healthcare settings, interprofessional teams do not always perform effectively. There is evidence that professional stereotypes inhibit effective interprofessional teamwork, but they haven't been explored as a phenomenon that impacts team's performance and quality of care. Objectives: To focus on professional stereotypes emerging in interprofessional teams and examine the contingency effects of interprofessional team's faultlines, professional stereotypes, and leader's championship behaviors on team's quality of care. Methods: A cross-sectional nested sample of 59 interprofessional teams and 284 professionals, working in geriatric long-term-care facilities in Israel. Additionally, five to seven of the residents of each facility were randomly sampled to obtain the outcome variable. Data collection employed a multisource (interprofessional team members), multimethod (validated questionnaires and data from residents' health records) strategy. Results: The results indicated that faultlines are not directly harmful to team's quality of care; instead, they are likely to impact quality of care only when team stereotypes emerge. Furthermore, whereas teams typified by high professional stereotypes require person-oriented championship leadership, for teams typified by low team stereotypes, championship leadership harms the quality of care they provide. Conclusion: These findings have implications for handling interprofessional teams. Practically, leaders must be well-educated to better analyze team members' needs and maintain the appropriate leadership style. [ABSTRACT FROM AUTHOR]

Failure mode and effect analysis (FMEA) is a leading tool for risk management in health care. The term "blanket" approach FMEA describes a comprehensive simultaneous look at the variety of interrelated factors that may directly and indirectly affect patient safety. Applying FMEA with the "blanket" approach is not common, due to FMEA's limitations. Algorithmic prediction of failure modes in health care (APFMH) is leaner and enables the application of the "blanket" approach, but, like FMEA, it lacks formal validation. The authors set out to validate the APFMH method while applying a "blanket" approach. They analyzed the sterile supply handling at a 1900-bed academic medical center. The study's first step took place in the operating room (OR) aspect of the process. An APFMH analysis was performed using the "blanket" approach, to identify the hazards and define the common root causes for predicted hazards. The second step took place a year later at the sterile supply and equipment department (SSED) and aimed to validate these root causes, thus validating the reliability of APFMH. The "blanket" approach analysis with the APFMH method consisted of categorization into 3 risk-dimensions: patient safety, equipment damage, and time management. Root causes were defined for 8 high-ranking hazards. All the root causes for failures, identified by APFMH at the OR department, were revealed as actual hazards in the processes of the SSED. The independent findings at the SSED level validated the list of identified hazards that was formed at the target department (ie, the OR). APFMH methodology is a lean in time and human resources process that ensures comprehensive hazard analysis, which can include the "blanket" approach, and which was validated in this study. The authors suggest using the APFMH methodology for any organizational analysis method that requires the inclusion of "blanket" approaches. [ABSTRACT FROM AUTHOR]