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ClassyFarm is an integrated surveillance system for monitoring the Italian livestock farms on risks related to antimicrobial use (AMU) and resistance (AMR) and other indicators, such as animal welfare and farm biosecurity. In the framework of the CoEvalAMR network we evaluated ClassyFarm by using three evaluation tools: the OH-EpiCap, the FAO PMP-AMR and the NEOH evaluation tool. Evaluation was performed by interviewing representatives of ClassyFarm, National Health System veterinarians, farm vets, farmers, livestock industry entrepreneurs, academy experts in AMR/AMU. NEOH and PMP-AMR evaluation tools were applied twice (at 2 years interval) to detect changes in the implementation of the system over time, while OH-EpiCap was applied once. The three tools differ in evaluation objectives, depth of analysis, and time/training resources needed to perform the evaluation. However, each of them enables to gather different information, which can serve as a basis for the discussion of possible adaptations/improvements of ClassyFarm. Even though ClassyFarm has a limited degree of One Health (OH) implementation, the evaluation showed that the system has evolved from a barely biosecurity and welfare surveillance system towards a more integrated OH approach. A transdisciplinary nature is also emerging, with the involvement of the environmental sector. However, there is space for improvement in resource allocation, data sharing and communication. Beyond the structural evaluation, surveillance systems should be evaluated also in relation to cost-effectiveness and system impacts.

Hydrotalcite materials (HTs) were synthesized by a facile and swift combined mechanochemistry/coprecipitation approach, and their catalytic activity was evaluated and compared with conventionally synthesized hydrotalcites (co-precipitation method) in the Knoevenagel condensation between furfural and ethyl cyanoacetate/malononitrile. Characterization and catalytic activity results clearly demonstrate that the proposed combined mechanochemical/coprecipitation approach provides an improvement in crystallinity, morphology, tunable basicity, and textural properties (higher surface area and enhanced surface properties) as compared to HTs obtained via conventional coprecipitation methods. In addition, mechanochemically synthesized HTs largely improve catalytic activities, including conversion and product selectivity to Knoevenagel condensation products under solventless conditions, short reaction times, or reaction at room temperature as compared to conventional counterparts (e.g., 30–40 vs > 99% product yields).

Abstract GdTe3 is a layered antiferromagnet which has attracted attention due to its exceptionally high mobility, distinctive unidirectional incommensurate charge density wave (CDW), superconductivity under pressure, and a cascade of magnetic transitions between 7 and 12 K, with as yet unknown order parameters. Here, we use spin-polarized scanning tunneling microscopy to directly image the charge and magnetic orders in GdTe3. Below 7 K, we find a striped antiferromagnetic phase with twice the periodicity of the Gd lattice and perpendicular to the CDW. As we heat the sample, we discover a spin density wave with the same periodicity as the CDW between 7 and 12 K; the viability of this phase is supported by our Landau free energy model. Our work reveals the order parameters of the magnetic phases in GdTe3 and shows how the interplay between charge and spin can generate a cascade of magnetic orders.

Abstract Background Machine learning (ML) can be promising for stratifying patients into homogeneous groups and assessing mortality based on score combination. Using ML, we compared mortality prediction performance for clustered and non-clustered models and tried to develop a simple decision algorithm to predict the patient’s cluster membership with classification and regression trees (CART). Methods Retrospective study involving patients requiring ICU admission (1st January 2011–16th September 2022). Clusters were identified by combining Charlson Comorbidity Index (CCI) plus Simplified Acute Physiology Score II (SAPS II) or Sequential Organ Failure Assessment (SOFA). Intercluster and survival analyses were performed. We analyzed the relationship with mortality with multivariate logistic regressions and receiver operating characteristic curves (ROC) for models with and without clusters. Nested models were compared with Likelihood Ratio Tests (LRT). Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were compared for non-nested models. With the best model, we used CART to build a decision tree for patient’s membership. Results Our sample consisted of 2605 patients (mortality 59.7%). For both score combinations, we identified two clusters (A and B for CCI + SAPS II, α and β for CCI + SOFA). Belonging to cluster B/β was associated with shorter survival times (Peto-Peto p-values

Objective This retrospective study (2020–2022) compared the usage patterns across international regions of an employer-provided digital mental health platform, which is available in native languages and offers both self-guided digital activities and one-on-one sessions. Methods Routine data from the platform were analyzed by describing the demographic profile of 178,119 users from different geographical regions, their baseline mental health status and burnout levels, as well as patterns of engagement. Statistical analyses were conducted using logistic and ordered logit models to examine the association between cumulative engagement with the platform over time and baseline characteristics. Results The platform had high engagement and satisfaction levels across regions and age groups. Female users were more engaged than males in both self-guided digital activities and one-on-one sessions. Older users and those from non-US regions were more engaged in self-guided digital activities, while younger users and those from the US were more engaged in one-on-one sessions. Symptoms of anxiety were also associated with engagement with one-on-one sessions. Conclusions The study's findings provide valuable insights into the benefits of digital platforms in addressing mental health needs of employers from different regions. Future research should focus on exploring the specific factors that influence engagement with digital mental health platforms and how these platforms can be optimized and tailored to better serve diverse populations.

Transgender individuals exhibit a higher prevalence of cancer-related risk factors, such as substance abuse and sexually transmitted infections. These factors, coupled with suboptimal adherence to cancer screening recommendations, may lead to a higher incidence of cancers, such as breast and cervical cancer, and contribute to delayed diagnoses in transgender patients. Herein, we report a unique case of a transgender man with a history of alcohol and drug abuse, undergoing gender-affirming exogenous testosterone therapy, who developed synchronous locally advanced breast cancer and human papilloma virus (HPV)-related cervical cancer. He underwent concurrent chemoradiation for cervical cancer and surgery followed by endocrine therapy for breast cancer. The treatments were suboptimals due to patient’s comorbidities, among them liver cirrhosis leading to an early death. Additionally, we have conducted a review of existing literature, including case reports, clinical studies, and review articles investigating the role of potential risk factors specifically related to breast and cervical tumors in transgender men. Gender-affirming testosterone therapy is common among transgender men to induce gender affirmation, but its link to breast cancer risk remains ambiguous, with studies being limited and sometimes contradictory. Conversely, HPV is a well-established cause of up to 99% of cervical cancers. Despite persistent risk for cervical cancer in transgender men who retain their cervix, several studies indicate notable disparities in screening adherence, due to personal and structural barriers. Moreover, alcohol and drug use disorders, commonly encountered in transgender population, may negatively influence the adherence to screening programs. Current cancer screening guidelines for this population are somewhat unclear, and specific programs based on more robust data are urgently required along with further tailored studies.

BackgroundDigital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown. ObjectiveThis study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website. MethodsVisitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages). ResultsParticipants chose to engage with the MHA website in 94.3% (15,161/16,078) of the sessions. Perceived need (β=.66; P

The aim of this study was to determine the anti-hypersensitivity activity of novel non-hallucinogenic compounds derived from iboga alkaloids (i.e., ibogalogs), including tabernanthalog (TBG), ibogainalog (IBG), and ibogaminalog (DM506), using mouse models of neuropathic (Chronic Constriction Injury; CCI) and visceral pain (dextrane sulfate sodium; DSS). Ibogalogs decreased mechanical hyperalgesia and allodynia induced by CCI in a dose- and timeframe-dependent manner, where IBG showed the longest anti-hyperalgesic activity at a comparatively lower dose, whereas DM506 displayed the quickest response. These compounds also decreased hypersensitivity induced by colitis, where DM506 showed the longest activity. To understand the mechanisms involved in these effects, two approaches were utilized: ibogalogs were challenged with the 5-HT2A receptor antagonist ketanserin and the pharmacological activity of these compounds was assessed at the respective 5-HT2A, 5-HT6, and 5-HT7 receptor subtypes. The behavioral results clearly demonstrated that ketanserin abolishes the pain-relieving activity of ibogalogs without inducing any effect per se, supporting the concept that 5-HT2A receptor activation, but not inhibition, is involved in this process. The functional results showed that ibogalogs potently activate the 5-HT2A and 5-HT6 receptor subtypes, whereas they behave as inverse agonists (except TBG) at the 5-HT7 receptor. Considering previous studies showing that 5-HT6 receptor inhibition, but not activation, and 5-HT7 receptor activation, but not inhibition, relieved chronic pain, we can discard these two receptor subtypes as participating in the pain-relieving activity of ibogalogs. The potential involvement of 5-HT2B/2 C receptor subtypes was also ruled out. In conclusion, the anti-hypersensitivity activity of ibogalogs in mice is mediated by a mechanism involving 5-HT2A receptor activation.

Purpose: To examine regional differences in disability status by sexual orientation and gender identity and to explore local factors that are associated with levels of inequalities for people who identify as lesbian, gay, bisexual, or other sexual orientations (LGB+) or transgender. Methods: This was a cross-sectional ecological analysis of 2021 Census data from England and Wales. The main outcome variable was disability status. The main explanatory variables were sexual orientation and gender identity. Weighed linear regression was used to examine differences in disability status by sexual orientation (LGB+ vs. heterosexual) and gender identity (transgender vs. cisgender). The magnitude of between-group differences was explored by region and, in England, local authority-level urbanization and socioeconomic deprivation. Results: Among 48.5 million census respondents within 331 local authority districts (LADs) across England and Wales, LGB+ and transgender groups were more likely to report having a disability than their heterosexual and cisgender counterparts. Inequalities were prevalent across regions of England and Wales, but were smallest in the Greater London area and largest in the southwest of England. Inequalities were also larger within English LADs that were relatively less urbanized and relatively more socioeconomically deprived. Conclusions: This study identified disparities in disability status by sexual orientation and gender identity, which varied by region and local socioeconomic deprivation and urbanization. More research is needed to better understand how to support disabled LGBT+ people, especially those in less urbanized and more socioeconomically deprived areas.

Abstract Background Monoclonal antibodies (mAbs) directed against tumour necrosis factor alpha (TNF‐α) and interleukin (IL)‐17 and ‐23 represent the ultimate therapeutic strategy in treating psoriasis patients, but scientific literature still does not provide conclusive results regarding the possible influence of previous biological therapies on real‐life therapeutic response. Objectives The objective of our work was to investigate any putative difference in the achievement and maintenance of PASI 75, 90 and 100, as well as the probability to achieve absolute PASI ≤ 1 and ≤3, between 305 bio‐naïve and bio‐experienced patients treated with anti‐IL mAbs. Methods A comparison between previous biologic and clinical factors, including relative and absolute PASI, was carried out through chi square test. Survival curves for the achievement of PASI 75, 90 and 100 and their differences were evaluated, performing a multivariate analysis (confidence interval 95%; p

Abstract Electronic Energy Transfer (EET) between chromophores is fundamental in many natural light-harvesting complexes, serving as a critical step for solar energy funneling in photosynthetic plants and bacteria. The complicated role of the environment in mediating this process in natural architectures has been addressed by recent scanning tunneling microscope experiments involving EET between two molecules supported on a solid substrate. These measurements demonstrated that EET in such conditions has peculiar features, such as a steep dependence on the donor-acceptor distance, reminiscent of a short-range mechanism more than of a Förster-like process. By using state of the art hybrid ab initio/electromagnetic modeling, here we provide a comprehensive theoretical analysis of tip-enhanced EET. In particular, we show that this process can be understood as a complex interplay of electromagnetic-based molecular plasmonic processes, whose result may effectively mimic short range effects. Therefore, the established identification of an exponential decay with Dexter-like effects does not hold for tip-enhanced EET, and accurate electromagnetic modeling is needed to identify the EET mechanism.

Background Access to diagnostic tools like chest radiography (CXR) is challenging in resource-limited areas. Despite reduced reliance on CXR due to the need for quick clinical decisions, its usage remains prevalent in the approach to neonatal respiratory distress syndrome (NRDS). Objectives To assess CXR’s role in diagnosing and grading NRDS severity compared to current clinical features and laboratory standards. Methods A review of studies with NRDS diagnostic criteria was conducted across six databases (MEDLINE, EMBASE, BVS, Scopus-Elsevier, Web of Science, Cochrane) up to 3 March 2023. Independent reviewers selected studies, with discrepancies resolved by a senior reviewer. Data were organised into descriptive tables to highlight the use of CXR and clinical indicators of NRDS. Results Out of 1,686 studies screened, 23 were selected, involving a total of 2,245 newborns. All selected studies used CXR to diagnose NRDS, and 21 (91%) applied it to assess disease severity. While seven reports (30%) indicated that CXR is irreplaceable by other diagnostic tools for NRDS diagnosis, 10 studies (43%) found that alternative methods surpassed CXR in several respects, such as severity assessment, monitoring progress, predicting the need for surfactant therapy, foreseeing Continuous Positive Airway Pressure failure, anticipating intubation requirements, and aiding in differential diagnosis. Conclusion CXR remains an important diagnostic tool for NRDS. Despite its continued use in scientific reports, the findings suggest that the study’s outcomes may not fully reflect the current global clinical practices, especially in low-resource settings where the early NRDS approach remains a challenge for neonatal survival. Trial registration: PROSPERO number CRD42022336480.

During acetabular cup positioning, intraoperative measurements of cup anteversion were taken using both fluoroscopy and navigation system. With the C-arm introduced at 40°, an anteroposterior view of the pelvis is taken. The C-arm is then centered over the hip, showing an anteverted cup with an approximate inclination of 40°. The axial C-arm is tilted away until the cup opening is visualized as a straight line, indicating that the beam of the fluoroscopy is aligned with the cup’s anteversion. The tilt angle on the C-arm and anteversion reading on the navigation workstation were recorded. The high degree of agreement between fluoroscopic and navigation measurement of acetabular cup anteversion supports the use of fluoroscopy in settings with limited access to navigation systems in direct anterior total hip arthroplasty.

Research on lesbian, gay, bisexual, transgender/gender expansive, and queer (LGBTQ) health is dominated by disparities in disease, access, and risk behaviors. Such research is critical for examining the myriad factors that limit the lives of gender and sexual minorities. Few studies, however, have explored LGBTQ people's concepts of health. People's accounts of health are important, as they reveal insights into a person's relationship to the social world and are fundamental to accessing care. Semi-structured, in-depth individual interviews were conducted with a diverse sample of 40 LGBTQ-identified adults living in New York City, aiming to explore (a) how LGBTQ people conceptualize health, and (b) how participant constructions of health reflect personal, social, cultural, and political subjectivities as well as institutionalized discourses of health and illness. Through framework analysis, four primary themes were identified: (1) health as medicine; (2) health as mind-body-spirit; (3) health as survival; and (4) health as access. Implications for the health professions, including patient-centered care, shared decision-making, and provider training, are discussed.

Background: Periprosthetic joint infection after total knee arthroplasty is commonly treated via 2-stage revision utilizing either articulating or static antibiotic cement spacers. While recent literature exhibits a slight functional advantage in favor of articulating spacers, those patients with a history of recurrent infection/multiple revision procedures are frequently excluded from these studies. The purpose of this study was to report infection eradication rates and efficacy of utilizing antibiotic-loaded locked intramedullary nail for infection for the multiply revised, infected total knee arthroplasty. Methods: A retrospective review was performed of all consecutive patients receiving static spacers between 2017 and 2020 at an academic medical center. Surgical techniques for all patients included irrigation and debridement using a reamer-irrigator-aspirator, injection of antibiotic-loaded calcium sulfate into the intramedullary canal, and nail placement. Antibiotic-loaded cement is then used to create a spacer block in the joint space. A Cox proportional hazard regression was run to identify risk factors for reinfection. Results: Forty-two knees in 39 patients were identified meeting inclusion criteria. Overall, there was an 68.8% infection eradication rate at an average of 46.9 months following spacer placement. The only risk factors identified on cox regression were increasing number of previous spacers, a surrogate for previous infections (hazards ratio = 14.818, P value = .021), and increasing operative time during spacer placement (hazards ratio = 1.014, P value = .039). Conclusions: Use of static spacers, in conjunction with reamer-irrigator-aspirator and antibiotic-loaded calcium sulfate, can be effective in treating chronic, complex periprosthetic joint infections in the setting of bone loss and or soft-tissue compromise and produced similar results to more simple infection scenarios.

Background and Aims: Hypoalbuminemia, as defined by serum albumin (SA) levels ≤35 g/L, is associated to venous and arterial thrombosis in general population and in patients at risk of cardiovascular disease. It is unknown if SA ≤35 g/L is also associated to portal vein thrombosis (PVT) in cirrhosis. Methods: Cirrhotic patients enrolled in the Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry (PRO-LIVER) study (n = 753), were followed-up for 2 years to assess the risk of PVT, that was diagnosed by Doppler ultrasonography. Child-Pugh classes, Model for End-Stage Liver Disease score, presence of hepatocellular carcinoma and laboratory variables including SA, D-dimer, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline. Results: SA ≤35 g/L was detected in 52% of patients. A logistic multivariate regression analysis showed that higher Child-Pugh class, hepatocellular carcinoma and thrombocytopenia were significantly associated to SA ≤35 g/L. In a subgroup of patients where data regarding hs-CRP and D-dimer were available, SA ≤35 g/L was inversely associated with hs-CRP and D-dimer. During the follow-up, a total of 61 patients experienced PVT. A Kaplan Meier survival analysis showed SA ≤35 g/L was associated to increased risk of PVT compared to SA >35 g/L (P = .005). A multivariate Cox proportional hazards regression analysis showed that male sex, lower platelet count, and SA ≤35 g/L remained associated to PVT after adjusting for confounding factors. Conclusion: Cirrhotic patients with SA ≤35 g/L are at higher risk of experiencing PVT compared to those with SA >35 g/L and could be considered as potential candidates to anticoagulant prophylaxis for PVT prevention.

In our experimental study, we explored the impact of maternal reduced heme oxygenase-1 (HO-1) gene (Hmox1)expression on the in vitro fertilization (IVF) rate through the use of heterozygous Hmox1 knockout mice models(HET/Hmox1+/ -). Also, we hypothesized a beneficial role of gametes exposure during fertilization to carbon monoxide(CO), one of HO-1 by-products, that might be relevant for the improvement of IVF rates. IVF technique wasperformed by using oocytes obtained from wild-type (WT) or Hmox1+/ - dams fertilized with WT, Hmox1+/ - orHmox1-/ - mice-derived sperm. The fertilization step occurred either in a conventional incubator (37°C, 5% CO2) or inan incubator implemented with CO (500 ppm). The superovulation yield of WT and Hmox1+/ - mice and the number offertilized oocytes was assessed using an optical microscope. The dams’ Hmox1 heterozygous knockout neither impactthe superovulation yield, nor did influence the fertilization success rate. Moreover, CO exposure during fertilizationcould not significantly improve the outcome. Our study showed that the maternal Hmox1+/ - condition is not affectingthe IVF rate in mice. Furthermore, we discovered that CO exposure cannot be exploited to ameliorate this critical stepof the IVF protocol.