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Abstract Insulin resistance impairs the cellular insulin response, and often precedes metabolic disorders, like type 2 diabetes, impacting an increasing number of people globally. Understanding the molecular mechanisms in hepatic insulin resistance is essential for early preventive treatments. To elucidate changes in insulin signal transduction associated with hepatocellular resistance, we employed a multi-layered mass spectrometry-based proteomics approach focused on insulin receptor (IR) signaling at the interactome, phosphoproteome, and proteome levels in a long-term hyperinsulinemia-induced insulin-resistant HepG2 cell line with a knockout of the insulin-like growth factor 1 receptor (IGF1R KO). The analysis revealed insulin-stimulated recruitment of the PI3K complex in both insulin-sensitive and -resistant cells. Phosphoproteomics showed attenuated signaling via the metabolic PI3K-AKT pathway but sustained extracellular signal-regulated kinase (ERK) activity in insulin-resistant cells. At the proteome level, the ephrin type-A receptor 2 (EphA2) showed an insulin-induced increase in expression, which occurred through the ERK signaling pathway and was concordantly independent of insulin resistance. Induction of EphA2 by insulin was confirmed in additional cell lines and observed uniquely in cells with high IR-to-IGF1R ratio. The multi-layered proteomics dataset provided insights into insulin signaling, serving as a resource to generate and test hypotheses, leading to an improved understanding of insulin resistance.

Abstract Freshwater macroinvertebrates are a diverse group and play key ecological roles, including accelerating nutrient cycling, filtering water, controlling primary producers, and providing food for predators. Their differences in tolerances and short generation times manifest in rapid community responses to change. Macroinvertebrate community composition is an indicator of water quality. In Europe, efforts to improve water quality following environmental legislation, primarily starting in the 1980s, may have driven a recovery of macroinvertebrate communities. Towards understanding temporal and spatial variation of these organisms, we compiled the TREAM dataset (Time seRies of European freshwAter Macroinvertebrates), consisting of macroinvertebrate community time series from 1,816 river and stream sites (mean length of 19.2 years and 14.9 sampling years) of 22 European countries sampled between 1968 and 2020. In total, the data include >93 million sampled individuals of 2,648 taxa from 959 genera and 212 families. These data can be used to test questions ranging from identifying drivers of the population dynamics of specific taxa to assessing the success of legislative and management restoration efforts.

Abstract The ongoing efforts to optimize rechargeable Li-ion batteries led to the interest in intercalation of nanoscale layered compounds, including bilayer graphene. Its lithium intercalation has been demonstrated recently but the mechanisms underpinning the storage capacity remain poorly understood. Here, using magnetotransport measurements, we report in-operando intercalation dynamics of bilayer graphene. Unexpectedly, we find four distinct intercalation stages that correspond to well-defined Li-ion densities. Transitions between the stages occur rapidly (within 1 sec) over the entire device area. We refer to these stages as ‘in-plane’, with no in-plane analogues in bulk graphite. The fully intercalated bilayers represent a stoichiometric compound C14LiC14 with a Li density of ∼2.7·1014 cm−2, notably lower than fully intercalated graphite. Combining the experimental findings and DFT calculations, we show that the critical step in bilayer intercalation is a transition from AB to AA stacking which occurs at a density of ∼0.9·1014 cm−2. Our findings reveal the mechanism and limits for electrochemical intercalation of bilayer graphene and suggest possible avenues for increasing the Li storage capacity.

Abstract Increasing evidence indicates contact with nature supports mental, physical and social health. However, beyond a widely reported number of barriers to nature contact, the constellation of motivations for human contact with nature is under‐theorised and under‐studied. We begin to develop indicators of autonomous and controlled motivations for nature contact informed by self‐determination theory. These include intrinsic motivation (i.e. enjoyment), integrated regulation (alignment with identify and life goals), identified regulation (a means to an end), introjected regulation (emotional reasons like guilt avoidance) and external regulation (such as peer pressure). We compare these motivation indices in a nationally representative sample of 5082 adults in Australia in 2022 with the Nature Relatedness Scale (NR6), and also test associations between them and five outcomes: time spent in nature, smartphone use in nature, interest in nature prescriptions, physical activity and self‐rated health. Statistical analyses were adjusted for potential confounding. Results demonstrate people have complex mixtures of motivations with varying potency for visiting natural settings and the extent to which those motives are autonomous or controlled matters for what they do, and the benefits accrued. For example, our analyses show that more direct considerations of intrinsic, integrated and identified forms of autonomous motivation have superior explanatory power than the NR6 for time spent in nature, interest in nature prescriptions, adherence to physical activity recommendations and self‐rated health. External regulations emphasising peer approval were associated not only with no additional time in nature but also with more distractive activities when in natural environments, as defined by more smartphone and social media use while there. While introjected regulations emphasising guilt avoidance were associated with increased nature contact, they were similarly associated with time spent on smartphones and social media when in natural environments, which has been shown to undermine restoration. Synthesis and applications: We need to formally measure autonomous and controlled motivations for nature contact to better understand both why some people visit natural environments, and whether they are mindfully maximising the health benefits of those experiences. This will help to inform robust nature‐based interventions that are acceptable, effective and sustainable for everyone. Read the free Plain Language Summary for this article on the Journal blog.

Abstract We examined three observations of green emission events (labeled as event A, B and C, respectively) associated with red sprites as captured by amateurs. In all cases, the green emissions were recorded atop of red sprite. Based on the location of causative strokes and background star fields for events A and B, their altitudes are confined between 88 and 100 km, with the maximum brightness at 90.7 and 95.5 km, respectively. Events B and C were lit up for a second time after the recurrence of a sprite element, extending their duration to approximately 1,084 ms and 732.6 ms, much longer than that (about 500 ms) for event A; the intensity of green emissions was also enhanced due to sprite recurrence. It is inferred that the recurrence of sprite elements could affect the ambient condition by further increasing electron density and strengthening the electric field for the ghost production.

Abstract Increasing evidence demonstrates the psychological benefits of nature contact. However, the evidence is often established at the population level, and the individual differences in the psychological benefits gained from nature are considered negligible variations. In this study, we performed a cross-sectional online survey in Brisbane and Sydney, Australia, from April 15th and May 15th, 2021 around one year after the first covid-19 pandemic lockdowns. The results show that individuals with a stronger connection to nature are linked with a lower level of stress and anxiety with increased frequency in public greenspace visits, while such an association is less clear for individuals with a weaker connection to nature. We also find that, through the answer to an open-ended question, individuals with a lower connection to nature tend to mention nature-related words less as the reason for visiting greenspace. This indicates that a person’s connection to nature is linked with how they interact with nature and thus might determine whether and how much psychological benefit a person gains from experiencing nature.

The European Larynx Organ Preservation Study (ELOS; NCT06137378) is a prospective, randomized, open-label, two-armed parallel group controlled, phase II multicenter larynx organ preservation (LOP) trial in locoregionally advanced (LA) stage III, IVA/B head and neck squamous cell carcinoma of the larynx or hypopharynx (LHSCC) amenable for total laryngectomy (TL) with PD-L1 expression within tumor tissue biopsy, calculated as CPS ≥ 1. Induction chemotherapy (IC) with docetaxel and cisplatin (TP) followed by radiation will be compared to TP plus PD-1 inhibition by pembrolizumab (MK-3475; 200 mg i.v. starting day 1 q3w for 17 cycles). After a short induction early response evaluation (ERE) 21 ± 3 days after the first cycle of IC (IC-1), responders achieving endoscopic estimated tumor surface shrinkage (ETSS) ≥30% will get an additional two cycles of IC followed by intensity-modulated radiotherapy 70–72 Gy (EQD2/α/β = 10) aiming at LOP. Nonresponders (ETSS < 30% or progressing disease) will receive TL and bilateral neck dissection followed by postoperative radiation or chemoradiation as recommended by the clinic’s multidisciplinary tumor board. Pembrolizumab treatment will be continued in the intervention arm regardless of ETSS status after IC-1 in both responders and laryngectomized nonresponders, independent of subsequent decisions on adjuvant therapy after TL.Clinical Trial Registrationclinicaltrials.gov, identifier NCT06137378.

Abstract Springtails (Collembola) inhabit soils from the Arctic to the Antarctic and comprise an estimated ~32% of all terrestrial arthropods on Earth. Here, we present a global, spatially-explicit database on springtail communities that includes 249,912 occurrences from 44,999 samples and 2,990 sites. These data are mainly raw sample-level records at the species level collected predominantly from private archives of the authors that were quality-controlled and taxonomically-standardised. Despite covering all continents, most of the sample-level data come from the European continent (82.5% of all samples) and represent four habitats: woodlands (57.4%), grasslands (14.0%), agrosystems (13.7%) and scrublands (9.0%). We included sampling by soil layers, and across seasons and years, representing temporal and spatial within-site variation in springtail communities. We also provided data use and sharing guidelines and R code to facilitate the use of the database by other researchers. This data paper describes a static version of the database at the publication date, but the database will be further expanded to include underrepresented regions and linked with trait data.

Abstract Spin-active quantum emitters have emerged as a leading platform for quantum technologies. However, one of their major limitations is the large spread in optical emission frequencies, which typically extends over tens of GHz. Here, we investigate single V4+ vanadium centres in 4H-SiC, which feature telecom-wavelength emission and a coherent S = 1/2 spin state. We perform spectroscopy on single emitters and report the observation of spin-dependent optical transitions, a key requirement for spin-photon interfaces. By engineering the isotopic composition of the SiC matrix, we reduce the inhomogeneous spectral distribution of different emitters down to 100 MHz, significantly smaller than any other single quantum emitter. Additionally, we tailor the dopant concentration to stabilise the telecom-wavelength V4+ charge state, thereby extending its lifetime by at least two orders of magnitude. These results bolster the prospects for single V emitters in SiC as material nodes in scalable telecom quantum networks.

Urban greening is threatened by the concern that street trees increase traffic-related injury/death. Associations between all serious and fatal traffic crashes and street tree percentages were examined in Sydney, Australia. Associations were adjusted for confounding factors relating to driver behavior (speeding, fatigue, and use of alcohol) and road infrastructure, including alignment (e.g., straight, curved), surface condition (e.g., dry, wet, ice), type (e.g., freeway, roundabout), and speed limit. Models indicated that 10% more street trees were associated with 3% and 20% higher odds of serious or fatal injuries and 20% tree collisions on roads of any speed, respectively. However, further analysis stratified by speed limit revealed contrasting results. Along roads of 70 km/h or greater, 10% more street trees were associated with 8% higher odds of serious or fatal injury and 25% higher odds of death. Comparable associations were not found between street trees and serious or fatal injuries along roads below 70 km/h. Reducing speed limits below 70 km/h saves lives and may mitigate risks of serious or fatal traffic accidents associated with street trees, enabling greener, cooler, healthier cities.

This study investigated the effectiveness of incorporating sulphur (S) with nitrogen (N) and phosphorus (P) for enhancing microbial activity in diesel-contaminated soil during ex-situ bioremediation. While N and P amendments are commonly used to stimulate indigenous microorganisms, the potential benefits of adding S have received less attention. The study found that historically contaminated soil with a moderate concentration of total petroleum hydrocarbons (TPH; 1270 mg/kg) did not have nutrient limitation, and incubation temperature was found to be more critical for enhancing microbial activity. However, soil spiked with an additional 5000 mg/kg of diesel showed increased activity following NP and NPS amendment. Interestingly, NPS amendment at 10 °C resulted in higher microbial activity than at 20 °C, indicating the potential for a tailored nutrient amendment approach to optimize bioremediation in cold conditions. Overall, this study suggests that incorporating S with N and P can enhance microbial activity in diesel-contaminated soil during ex-situ bioremediation. Furthermore, the study highlights the importance of considering incubation temperature in designing a nutrient amendment approach for bioremediation, especially in cold conditions. These findings can guide the design and implementation of future effective bioremediation strategies for petroleum hydrocarbon-contaminated soil.

A novel eco-friendly high throughput continuous hydrothermal flow system was used to synthesise phase pure ZnO and doped ZnO in order to explore their properties for tissue engineering applications. Cerium, zirconium, and copper were introduced as dopants during flow synthesis of ZnO nanoparticles, Zirconium doped ZnO were successfully synthesised, however secondary phases of CeO and CuO were detected in X-ray diffraction (XRD). The nanoparticles were characterised using X-ray diffraction, Brunauer-Emmett-Teller (BET), Dynamic Light scattering Measurements, Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), Fourier transform infrared spectroscopy (FT-IR) and RAMAN spectroscopy was used to evaluate physical, chemical, and structural properties. The change in BET surface area was also significant, the surface area increased from 11.35 (ZnO_2) to 26.18 (ZrZnO_5). However. In case of CeZnO_5 and CuZnO_5 was not significant 13.68 (CeZnO_5) and 12.16 (CuZnO_5) respectively. Cell metabolic activity analysis using osteoblast-like cells (MG63) and human embryonic derived mesenchymal stem cells (hES-MP) demonstrated that doped ZnO nanoparticles supported higher cell metabolic activity compared to cells grown in standard media with no nanoparticles added, or pure zinc oxide nanoparticles. The ZrZnO_5 demonstrated the highest cell metabolic activity and non-cytotoxicity over the duration of 28 days as compared to un doped or Ce or Cu incorporated nanoparticles. The current data suggests that Zirconium doping positively enhances the properties of ZnO nanoparticles by increasing the surface area and cell proliferation. Therefore, are potential additives within biomaterials or for tissue engineering applications.

Health benefits from urban greening are assumed to translate into reduced healthcare expenditure, yet few studies have tested this. A total of 110,134 participants in the Sax Institute’s 45 and Up Study in the Australian cities of Sydney, Newcastle, or Wollongong were linked with hospital cost data for cardiovascular disease (CVD) events (e.g., acute myocardial infarctions) up to 30 June 2018. Associations between percentages of total green space, tree canopy, and open grass within 1.6 km of participants homes and annual per person measured CVD-related hospital costs were analysed using generalised linear model (GLM) with gamma density as a component of a two-part mixture model, adjusting for confounders. Overall, 26,243 participants experienced a CVD-related hospitalisation. Incidence was lower among participants with 10 % more tree canopy (OR 0.98, 95 %CI 0.96, 0.99), but not with higher total green space or open grass percentages. Total costs of hospitalisations per year were lower with 10 % more tree canopy (means ratio 0.96, 95 %CI 0.95, 0.98), but also higher with 10 % more open grass (means ratio 1.04, 95 %CI 1.02, 1.06). It was estimated that raising tree canopy cover to 30 % or more for individuals with currently less than 10 % could lead to a within-sample annual saving per person of AU$ 193 overall and AU$ 569 for those who experienced one or more CVD-related hospital admissions. This projects to an estimated annual health sector cost reduction of AU$ 19.3 million per 100,000 individuals for whom local tree canopy cover is increased from less than 10 % to 30 % or higher. In conclusion, this longitudinal study is among the first to analyse measured healthcare cost data in relation to urban green space in general, and with differentiation between major types of greenery relevant to urban planning policies in cities around the world. In sum, this study advances an increasingly important and international focus of research by reporting on the lower burden of CVD and fewer associated hospitalisations stemming from upstream investments that protect and restore urban tree canopy, which not only translates into substantial reduced costs for the health sector, but also helps to create regenerative cities and flourishing communities.

Abstract Background Previous studies have demonstrated the efficacy of rehabilitation after a cardiovascular procedure. Especially older and multimorbid patients benefit from rehabilitation after a cardiac procedure. Prehabilitation prior to cardiac procedures may also have positive effects on patients’ pre- and postoperative outcomes. Results of a current meta-analysis show that prehabilitation prior to cardiac procedures can improve perioperative outcomes and alleviate adverse effects. Germany currently lacks a structured cardiac prehabilitation program for older patients, which is coordinated across healthcare sectors. Methods In a randomized, controlled, two-arm parallel group, assessor-blinded multicenter intervention trial (PRECOVERY), we will randomize 422 patients aged 75 years or older scheduled for an elective cardiac procedure (e.g., coronary artery bypass graft surgery or transcatheter aortic valve replacement). In PRECOVERY, patients randomized to the intervention group participate in a 2-week multimodal prehabilitation intervention conducted in selected cardiac-specific rehabilitation facilities. The multimodal prehabilitation includes seven modules: exercise therapy, occupational therapy, cognitive training, psychosocial intervention, disease-specific education, education with relatives, and nutritional intervention. Participants in the control group receive standard medical care. The co-primary outcomes are quality of life (QoL) and mortality after 12 months. QoL will be measured by the EuroQol 5-dimensional questionnaire (EQ-5D-5L). A health economic evaluation using health insurance data will measure cost-effectiveness. A mixed-methods process evaluation will accompany the randomized, controlled trial to evaluate dose, reach, fidelity and adaptions of the intervention. Discussion In this study, we investigate whether a tailored prehabilitation program can improve long-term survival, QoL and functional capacity. Additionally, we will analyze whether the intervention is cost-effective. This is the largest cardiac prehabilitation trial targeting the wide implementation of a new form of care for geriatric cardiac patients. Trial registration German Clinical Trials Register (DRKS; http://www.drks.de ; DRKS00030526). Registered on 30 January 2023.

Link worker social prescribing programs are gaining recognition in Australia for addressing health and social needs outside routine medical care. The evaluation of these programs is essential for informing future social prescribing programs, research and evolving policy. However, diverse outcome evaluation measures present challenges for benchmarking across link worker social prescribing programs. An integrative review was conducted to identify and describe outcome domains and measures, and the methodological approaches and evaluation designs of link worker social prescribing programs in Australia. Comprehensive searches of the literature on link worker social prescribing programs in Australia were conducted across 14 electronic databases. In order to reduce the risk of bias, study selection and data extraction were conducted independently by multiple authors, and included studies underwent quality and risk of bias assessment using the standardised Mixed Methods Appraisal Tool. Six studies met the inclusion criteria. Outcome domains were categorised into 'person-level', 'system-level' and 'program implementation' domains. Despite the variation in participant groups, the 'person-level' domains of global well-being and social well-being were consistently evaluated. While measurement tools varied significantly, the WHO Quality of Life Brief Assessment and short-form UCLA Loneliness Scale were most commonly applied. At the system level, health service utilisation was primarily evaluated. This integrative review reports on the current state of evidence in Australia, with the potential to track changes and trends over time. Developing a core outcome set, incorporating stakeholder and consumer contributions for benchmarking aligned with the healthcare landscape is recommended. The findings may guide the refining of social prescribing initiatives and future research, ensuring methodological robustness and alignment with individual and community needs.

Background: The timing of treatment for chronic aortic valve regurgitation (AR), especially in asymptomatic patients, is gaining attention since less invasive strategies have become available. The aim of the present study was to evaluate left ventricular reverse remodeling after aortic valve replacement (AVR) for severe AR. Methods: Patients (n = 25) who underwent surgical AVR for severe AR with left ventricular ejection fraction (LVEF) less than 55% were included in this study. Preprocedural and follow-up clinical and echocardiographic measurements of LVEF and left ventricular (LV) diameters were retrospectively analyzed. Results: Mean LVEF increased significantly following surgical AVR (p < 0.0001). LV diameters showed a clear regression (p = 0.0088). Younger patients and those receiving a mechanical valve tended to have less improved LVEF on follow-up than patients over 60 years or the ones who were implanted with a biological prosthesis (p = 0.0239 and p = 0.069, respectively). Gender had no effect on the degree of LVEF improvement (p = 0.4908). Conclusions: We demonstrated significant LV reverse remodeling following AVR for AR. However, more data are needed on LV functional and geometrical improvement comparing the different types of valve prostheses to provide an optimal treatment strategy.

A healthy ocean is essential for human health, and yet the links between the ocean and human health are often overlooked. By providing new medicines, technologies, energy, foods, recreation, and inspiration, the ocean has the potential to enhance human health and wellbeing. However, climate change, pollution, biodiversity loss, and inequity threaten both ocean and human health. Sustainable realisation of the ocean’s health benefits will require overcoming these challenges through equitable partnerships, enforcement of laws and treaties, robust monitoring, and use of metrics that assess both the ocean’s natural capital and human wellbeing. Achieving this will require an explicit focus on human rights, equity, sustainability, and social justice. In addition to highlighting the potential unique role of the healthcare sector, we offer science-based recommendations to protect both ocean health and human health, and we highlight the unique potential of the healthcare sector tolead this effort.

Abstract ESCAPE Evaluation of a patient‐centred biopsychosocial blended collaborative care pathway for the treatment of multimorbid elderly patients. Therapeutic Area Healthcare interventions for the management of older patients with multiple morbidities. Aims Multi‐morbidity treatment is an increasing challenge for healthcare systems in ageing societies. This comprehensive cohort study with embedded randomized controlled trial tests an integrated biopsychosocial care model for multimorbid elderly patients. Hypothesis A holistic, patient‐centred pro‐active 9‐month intervention based on the blended collaborative care (BCC) approach and enhanced by information and communication technologies can improve health‐related quality of life (HRQoL) and disease outcomes as compared with usual care at 9 months. Methods Across six European countries, ESCAPE is recruiting patients with heart failure, mental distress/disorder plus ≥2 medical co‐morbidities into an observational cohort study. Within the cohort study, 300 patients will be included in a randomized controlled assessor‐blinded two‐arm parallel group interventional clinical trial (RCT). In the intervention, trained care managers (CMs) regularly support patients and informal carers in managing their multiple health problems. Supervised by a clinical specialist team, CMs remotely support patients in implementing the treatment plan—customized to the patients' individual needs and preferences—into their daily lives and liaise with patients' healthcare providers. An eHealth platform with an integrated patient registry guides the intervention and helps to empower patients and informal carers. HRQoL measured with the EQ‐5D‐5L as primary endpoint, and secondary outcomes, that is, medical and patient‐reported outcomes, healthcare costs, cost‐effectiveness, and informal carer burden, will be assessed at 9 and ≥18 months. Conclusions If proven effective, the ESCAPE BCC intervention can be implemented in routine care for older patients with multiple morbidities across the participating countries and beyond.

Abstract Urban dwellers’ use of public and private green spaces may have changed during the early years of the Covid-19 pandemic due to movement restriction. A survey was deployed in Brisbane and Sydney, Australia 1 year after the start of Covid-19 restrictions (April 2021) to explore relationships of mental health and wellbeing to different patterns of private yard versus public green space visitation. More frequent yard use during the initial year of Covid-19 was correlated with lower stress, depression, and anxiety and higher wellbeing. However, greater duration of yard visits (week prior to survey) was associated with higher stress, anxiety, and depression scores, potentially because individuals may seek to use nature spaces immediately available for emotional regulation during difficult times. The results highlight the importance of yards for mental health and wellbeing during the Covid-19 pandemic and that relationships between nature interaction and mental health may be context and timeframe dependent.

Abstract Background Traumatic musculoskeletal injuries are a common presentation to emergency care, the first-line investigation often being plain radiography. The interpretation of this imaging frequently falls to less experienced clinicians despite well-established challenges in reporting. This study presents novel data of clinicians’ confidence in interpreting trauma radiographs, their perception of AI in healthcare, and their support for the development of systems applied to skeletal radiography. Methods A novel questionnaire was distributed through a network of collaborators to clinicians across the Southeast of England. Over a three-month period, responses were compiled into a database before undergoing statistical review. Results The responses of 297 participants were included. The mean self-assessed knowledge of AI in healthcare was 3.68 out of ten, with significantly higher knowledge reported by the most senior doctors (Specialty Trainee/Specialty Registrar or above = 4.88). 13.8% of participants reported an awareness of AI in their clinical practice. Overall, participants indicated substantial favourability towards AI in healthcare (7.87) and in AI applied to skeletal radiography (7.75). There was a preference for a hypothetical system indicating positive findings rather than ruling as negative (7.26 vs 6.20). Conclusions This study identifies clear support, amongst a cross section of student and qualified doctors, for both the general use of AI technology in healthcare and in its application to skeletal radiography for trauma. The development of systems to address this demand appear well founded and popular. The engagement of a small but reticent minority should be sought, along with improving the wider education of doctors on AI.

Background: There is an urgent need to seek innovative and alternative interventions that can be used alongside traditional mental health treatments. Despite a variety of benefits, nature has been underutilised in supporting individuals with mental health conditions. This study explored the experiences of ten people attending a mental health rehabilitation service who participated in a pilot Nature Walking Group implemented within community mental health services in NSW Australia. Methods: Two ten-week Nature Walking Groups were implemented. Data include ethnographic observations of the walks, focus group and interviews with the participants. The research team used an individual and collective thematic analysis of the social practices described in the data. Results: Ten people aged between 37 and 66 years participated in the walking groups (four in group 1 and six in group 2). Three major themes were identified in the data and participants’ words were used to name each theme. Theme 1 - ``I can get to a happy place by visiting nature'' refers to participants’ accounts of the activity's impact on their mental health. Theme 2 - ``Knowing that you are not alone'' incorporates experiences of social connection and participant interactions. Theme 3 - ``It was really rewarding and helpful'' describes participants’ satisfaction with how the groups were organised and run and the elements they enjoyed the most. Conclusions: All participants experienced benefits from participating in the groups including feeling calmer, having improved mood and feeling less alone with their mental health problems. Joining the NWG as part of their treatment was viewed as a legitimate intervention for mental health services to implement. Nature walking groups for people with mental health conditions have huge potential as a non-clinical intervention. However, more work on how they can be implemented and sustained is required.

Introduction Two known major risk factors for oral squamous cell carcinoma are smoking and alcohol consumption. Environmental tobacco smoke (also known as secondhand smoke) has been proven to be associated with the occurrence of lung and breast carcinoma. This study aimed to assess exposure to environmental tobacco smoke and its association with the development of oral squamous cell carcinomas. Methods Using a standardized questionnaire, 165 cases and 167 controls were asked about their demographic data and risk behaviors, including environmental tobacco smoke exposure. An environmental tobacco smoke score (ETS-score) was developed to semi-quantitatively record the previous exposure to ETS. Statistical analyses were performed with χ 2 test or Fishers exact test, and with ANOVA or Welch’s t-test as appropriate. An analysis was done using multiple logistic regression. Results Cases had a significantly increased previous exposure to environmental tobacco smoke compared to the controls (ETS-score: 36.69 ± 26.34 vs 13.92 ± 12.44; p

Abstract Introduction Avoidance of health services, in particular hospital and community services, is problematic for people with diabetes. Evidence has demonstrated that such missed attendances are associated with worse health, faster declines in functioning, and higher rates of mortality long-term. This paper investigated the impact of the pandemic on healthcare access across community and hospital care, including Virtual Care (VC) using several large datasets of General Practice (GP) and hospital services in western Sydney. Methods A retrospective cohort study using a time-series database of 173,805 HbA1c tests done at Blacktown and Mt Druitt hospitals and 1.8 million recorded consultations at GP clinics in the region was undertaken. Results The average rate of diabetes in Emergency Department fell from 17.8% pre-pandemic to 11% after January 2020 (p

In this case study, the researcher examines how three elementary teachers, all certified by their school district in culturally responsive teaching (CRT) through professional development (PD) opportunities, implement CRT in mathematics. The study was designed to understand 1) the CRT certification process and structures that were intended to support teachers in the focal district, and 2) how the teachers were enacting CRT in mathematics based on these experiences. Data were collected via interviews, questionnaires, observations, teacher journals, and other reportable data. The teachers were enacting CRT practices that aligned with Hammond's (2015) Ready for Rigor framework, which includes awareness, learning partnerships, community of learners, and information processing. Yet, at times, the teachers engaged in CRT practices that were more thoroughly captured in other literature, including that in mathematics education. Thus, the researcher created an adapted model to display these findings about practice across four quadrants. From these findings, researchers in mathematics education may gain a more informed understanding of how elementary teachers may enact CRT in mathematics based on their backgrounds and experiences with a district-developed and applied certification model, rather than a researcher-designed PD with selected participants of practicing teachers.

Both nanopore-based DNA sequencing and CRISPR/Cas-based gene editing represent groundbreaking innovations in molecular biology and genomics, offering unprecedented insights into and tools for working with genetic information. For students, reading, editing, and even writing DNA will be part of their everyday life. We have developed a laboratory procedure that includes (i) the biosynthesis of a guide RNA for, (ii) targeting Cas9 to specifically linearize the pBR322 plasmid, and (iii) the identification of the cutting site through nanopore DNA sequencing. The protocol is intentionally kept simple and requires neither living organisms nor biosafety laboratories. We divided the experimental procedures into separate activities to facilitate customization. Assuming access to a well-equipped molecular biology laboratory, an initial investment of approximately $2,700 is necessary. The material costs for each experiment group amount to around $130. Furthermore, we have developed a freely accessible website (https://dnalesen.hs-mittweida.de) for sequence read analysis and visualization, lowering the required computational skills to a minimum. For those with strong computational skills, we provide instructions for terminal-based data processing. With the presented activities, we aim to provide a hands-on experiment that engages students in modern molecular genetics and motivates them to discuss potential implications. The complete experiment can be accomplished within half a day and has been successfully implemented by us at high schools, in teacher training, and at universities. Our tip is to combine CRISPR/Cas gene targeting with nanopore-based DNA sequencing. As a tool, we provide a website that facilitates sequence data analysis and visualization.

The technology-supported education systems seamlessly integrated throughout the globe in response to the demands of post COVID-19 pandemic. The swift developments of the digital tools with Artificial Intelligence (AI) support are also readily diffused among the educational communities. This research paper investigates the synergistic impact of digital literacy, the incorporation of AI tools, and Peer Supported Collaborative Learning (PSCL) on the learning perceptions of university students. The research aims to discern the implications of these technological and social facets on students' attitudes towards AI assisted learning process. Structured questionnaire-based survey among the University students were done for this descriptive research. 409 responses collected were analysed with SPSS, Excel and Process Macro. It is found that the students' Digital Literacy, Use of AI tools and PSCL on AI assisted learning were positively correlated. The partial mediatory path through the PSCL and AI tool usage has a significant positive influence on students learning process. The insights gathered from this study can inform educators, policymakers, and institutions on optimizing the amalgamation of digital literacy, AI tools and PSCL to enhance the contemporary learning environment. As universities navigate the digital age, this research provides a nuanced understanding of the dynamics shaping students' perceptions, offering valuable insights into the multifaceted aspects of AI influencing the educational landscape.

In higher education, generative chatbots have infiltrated teaching and learning. Concerns about how and if to utilize chatbots in the classroom are at the forefront of scholarly discussion. This quick-hit article presents a plan to teach learners about generative AI writing tools and their ethical use for writing purposes. As generative AI tools continue to emerge, this guide can support instructors from all disciplines to engage learners in getting the most accurate information.

Abstract Background The advance directive represents patients’ health care choices and fosters patients’ autonomy. Nevertheless, understanding patients’ wishes based on the information provided in advance directives remains a challenge for health care providers. Based on the ethical premises of positive obligation to autonomy, an advanced directive that is disease-centred and details potential problems and complications of the disease should help health care providers correctly understand patients’ wishes. To test this hypothesis, a pilot-study was conducted to investigate whether physicians could make the correct end-of-life decision for their patients when patients used a disease-centred advance directive compared to a common advance directive. Material and methods A randomised, controlled, prospective pilot study was designed that included patients with non-small cell lung cancer (NSCLC) stage VI from the Department of Haematology and Medical Oncology, University Medical Centre, Goettingen. Patients were randomised into intervention and control groups. The control group received a common advance directive, and the intervention group received a disease-centred advance directive. Both groups filled out their advance directives and returned them. Subsequently, patients were asked to complete nine medical scenarios with different treatment decisions. For each scenario the patients had to decide whether they wanted to receive treatment on a 5-point Likert scale. Four physicians were given the same scenarios and asked to decide on the treatment according to the patients’ wishes as stated in their advance directives. The answers by patients and physicians were then compared to establish whether physicians had made the correct assumptions. Results Recruitment was stopped prior to reaching anticipated sample target. 15 patients with stage IV NSCLC completed the study, 9 patients were randomised into the control group and 6 patients in the intervention group. A total of 135 decisions were evaluated. The concordance between physicians’ and patients’ answers, was 0.83 (95%-CI 0.71–0.91) in the intervention group, compared to 0.60 (95%-CI 0.48–0.70) in the control group, and the difference between the two groups was statistically significant (p = 0.005). Conclusion This pilot study shows that disease-centred advance directives help physicians understand their NSCLC patients’ wishes more precisely and make treatment choices according to these wishes. Trial registration The study is registered at the German Clinical Trial Register (no. DRKS00017580, registration date 27/08/2019).

ObjectiveCardiac surgery is known to activate a cascade of inflammatory mediators leading to a systemic inflammatory response. Hemadsorption (HA) devices such as CytoSorb® have been postulated to mitigate an overshooting immune response, which is associated with increased morbidity and mortality, and thus improve outcome. We aimed to investigate the effect of CytoSorb® on interleukin (IL)-6 levels in patients undergoing complex cardiac surgery in comparison to a control group.MethodsA total of 56 patients (28 CytoSorb®, 28 control) undergoing acute and elective cardiac surgery between January 2020 and February 2021 at the Department of Cardiac and Vascular Surgery, Clinic Floridsdorf, Vienna, were retrospectively analyzed. The primary endpoint was the difference in IL-6 levels between the CytoSorb® and control group. Secondary endpoint was periprocedural mortality.ResultsCytoSorb®, installed in the bypass circuit, had no significant effect on IL-6 levels. IL-6 peaked on the first postoperative day (HA: 775.3 ± 838.4 vs. control: 855.5 ± 1,052.9 pg/ml, p = 0.856). In total, three patients died in the HA group, none in the control (logistic regression model, p = 0.996). Patients with an increased Euroscore II of 7 or more showed a reduced IL-6 response compared to patients with an Euroscore II below 7 (178.3 ± 63.1 pg/ml vs. 908.6 ± 972.6 pg/ml, p-value = 0.00306).ConclusionsNo significant reduction of IL-6 levels or periprocedural mortality through intraoperative HA with CytoSorb® in patients undergoing cardiac surgery was observed. However, this study was able to show a reduced immunologic response in patients with a high Euroscore II. The routine application of CytoSorb® in cardiac surgery to reduce inflammatory mediators has to be scrutinized in future prospective randomized studies.

Concerns over valuation accuracy and variance cannot be over-flogged, given the somewhat fluid nature of these concepts. It is however, more apt to dig into their fundamental causative factors. This paper realizes that specialist valuer or appraiser has a chain of sequential tasks anchored on his distinguishing competencies. At the heart of this is sufficient knowledge of the attributes of his subject of valuation. Twenty-two (22) Nigerian valuers based within Lagos Metropolis were made to carry out valuation assessment of selected landed and non-landed property assets and were also examined on their perception of the adequacy of their acquired Body of Knowledge (BOK) relevant to each asset category. The variation/dispersion in their valuations is revealed by the Standard Deviation of the distribution, for Landed Property, being 7.77 while that of Non-Landed Property is 32.24; By employing the 10% maximum variation rule of Glover (1985), 9% of the valuers fall outside the limit in respect of Landed Property whereas, the figure rose to 64% for Non-Landed Property assets. This is indicative of remarkably higher internal inconsistencies among respondent valuers on Non-Landed Property Assets. Multiple regression analysis of the results indicated that all the adaptive knowledge variables exert positive influence on valuer’s competence in valuation of both Landed Property and Non-Landed Property Assets. In view of these findings, there is urgent need to review and expand underlying curriculum for training prospective valuers towards aligning theory with practice and enhance their competence across property types.

Abstract Background Postoperative delirium is a common complication of cardiac surgery associated with higher morbidity, longer hospital stay, risk of cognitive decline, dementia, and mortality. Geriatric patients, patients undergoing cardiac surgery, and intensive care patients are at a high risk of developing postoperative delirium. Gold standard assessments or biomarkers to predict risk factors for delirium, cognitive decline, and dementia in patients undergoing cardiac surgery are not yet available. Methods The FINDERI trial (FINd DElirium RIsk factors) is a prospective, single-center, observational study. In total, 500 patients aged ≥ 50 years undergoing cardiac surgery at the Department of Cardiovascular and Thoracic Surgery of the University of Göttingen Medical Center will be recruited. Our primary aim is to validate a delirium risk assessment in context of cardiac surgery. Our secondary aims are to identify specific preoperative and perioperative factors associated with delirium, cognitive decline, and accelerated dementia after cardiac surgery, and to identify blood-based biomarkers that predict the incidence of postoperative delirium, cognitive decline, or dementia in patients undergoing cardiac surgery. Discussion This prospective, observational study might help to identify patients at high risk for delirium prior to cardiac surgery, and to identify important biological mechanisms by which cardiac surgery is associated with delirium. The predictive value of a delirium screening questionnaire in cardiac surgery might be revealed. Finally, the identification of specific blood biomarkers might help to predict delirium, cognitive decline, and dementia in patients undergoing cardiac surgery. Trial registration: Ethics approval for this study was obtained from the IRB of the University of Göttingen Medical Center. The investigators registered this study in the German Clinical Trials Register (DRKS; https://www.drks.de ) (DRKS00025095) on April 19th, 2021.

Abstract Background Mental health conditions are one of the largest burdens of disease in Australia and globally. There is a need to seek innovative and alternative interventions that can prevent and alleviate mental health symptoms. Nature-based interventions (NBIs), namely programs and activities where individuals engage with natural environments with the aim of improving their health and wellbeing (e.g., nature walking groups), may be such an alternative. This study aimed to explore the perceptions of mental health clinicians on the potential benefits of, and barriers to, implementing NBIs within a community mental health setting. Methods This study used a qualitative, exploratory research design. Fifteen mental health clinicians were recruited from the Illawarra Shoalhaven Local Health District, Australia, and interviewed (September–October 2021) about their perceptions of NBIs within mental health settings. The semi-structured interviews were analysed using an inductive thematic approach and managed with NVivo. Results Mental health clinicians viewed spending time in nature as relaxing, refreshing, and therapeutic. Many described it as part of their lifestyle and encouraged consumers to engage in nature-based activities on their own time. If NBIs were to be introduced as part of mental health services, clinicians expressed willingness to promote them to their consumers. Clinicians listed many potential benefits of NBIs for mental health consumers including improved mood, calmness and relaxation, a sense of empowerment, and social connections. Despite these benefits, clinicians were concerned about a variety of barriers to NBIs including consumers’ mental health symptoms such as anxiety or lack of motivation, scepticism, and geographic accessibility, as well as organisational barriers such as policies around safety risk. Conclusion Responding to the individual and organisational factors that could hinder the implementation of NBIs while building on the existing evidence of the positive impact of nature on health and wellbeing and, as demonstrated in this study, mental health clinicians’ interest and supportiveness of NBIs, mental health services should consider the implementation of NBIs as part of routine practice.

Pandemic control policy requires balancing economic and disease outcomes. This study develops a joint modeling approach that allows both aspects to be considered simultaneously and shows that targeted isolation is superior economically and can achieve similar disease outcomes to voluntary isolation or blanket lockdowns.

ABSTRACT Addressing the seminal pathophysiology in Alzheimer disease (AD) is the next logical focus for effective intervention, given the initial disappointing and more recent possibly encouraging results of monoclonal antibody trials. Endothelial cell dysfunction induced blood brain barrier leak (BBB) with associated prolonged capillary mean transit time (cMTT) and glymphatic outflow dysfunction are the most proximal events in the degeneration cascade. Sensitive and reproducible markers are required to both identify early disease and assess future treatment trial outcomes. Two participants with mild cognitive impairment (MCI) and one with AD, were evaluated clinically prior to MRI in this small case series report. From seven 3D Turbo Gradient and Spin Echo (TGSE) Pulsed Arterial Spin Echo (PASL) MRI sequences six homologous region of interest (ROI) in bitemporal, bifrontal, and biparietal lobes for each sequence were examined and plotted against time. By choosing late perfusion times during cMTT phase of perfusion linear analysis of signal decay could be utilized. A reference axial FLAIR sequence was also obtained. Slope of the linear analysis correlated to the rate of labeled proton clearance with reduced clearance occurring in AD participants compared to normal participants in our previous study. Whether similar differences in clearance rate extends to either MCI or early AD was investigated. Participants were categorized by clinical phenotype before MRI and compared to previously published phenotype cohorts: n=18 normal/healthy, n=6 AD, n=3 MCI. Significant differences in labeled proton clearance rates between AD and MCI/control phenotypes within bilateral temporal lobes (Left p=0.004, Right p=0.002) and within bilateral frontal lobes AD vs. controls (Left p=0.001, Right p=0.008) and AD vs. MCI (Left p=0.001, Right p=0.001) were found. This non-invasive MRI technique has potential for identifying MCI transition to AD.

IntroductionMulti-professional interdisciplinary tumor boards (ITB) are essential institutions to discuss all newly diagnosed, relapsed or complex cancer patients in a team of specialists to find an optimal cancer care plan for each individual patient with regard to national and international clinical practice guidelines, patient´s preference and comorbidities. In a high-volume cancer center, entity-specific ITBs take place at least once a week discussing a large number of patients. To a high level of expertise and dedication, this also requires an enormous amount of time for physicians, cancer specialists and administrative support colleagues, especially for radiologists, pathologists, medical oncologists and radiation oncologists, who must attend all cancer-specific boards according to certification requirements.MethodsIn this 15-month prospective German single-center analysis, we examined the established structures of 12 different cancer-specific ITBs at the certified Oncology Center and demonstrate tools helping to optimize processes before, during and after the boards for optimal, time-saving procedures.ResultsBy changing pathways, introducing revised registration protocols and new digital supports we could show that the workload of preparation by radiologists and pathologists could be reduced significantly by 22.9% (p=

ObjectivePrevious symptom prevalence studies show a diverse spectrum of symptoms and a large diversity in symptom intensities in patients being just diagnosed as having incurable cancer. It is unclear, how physical symptoms and psychosocial burden should be recorded in order to determine the variable need for palliative care and further support. Therefore, we compared two different strategies for detecting physical symptoms and psychosocial burden of patients with newly diagnosed incurable cancer and their effects on the further course of the disease.MethodsSCREBEL is a controlled, randomized, non-blinded, longitudinal study of the research network of the Palliative Medicine Working Group (APM) of the German Cancer Society (DKG). We compared: a less complex repeated brief screening for symptoms and burden in patients using the NCCN Distress Thermometer and IPOS questionnaire versus a multidimensional comprehensive assessment using the FACT-G and their entity-specific questionnaires, the PHQ4 scales, SCNS-34-SF, IPOS and NCCN Distress Thermometer. The primary study endpoint was quality of life (QoL), measured using FACT-G, after six months. Secondary study endpoints were QoL by using evaluation of secondary scores (NCCN DT, IPOS, PHQ4, SCNS-SF-34G) at time 6 months, the number of hospital days, the utilization of palliative care, emergency services, and psychosocial care structures. To assess effects and differences, multiple linear regression models were fitted and survival analyses were conducted.Results504 patients were included in the study. 262 patients were lost to follow-up, including 155 fatalities. There were no significant differences between the low-threshold screening approach and a comprehensive assessment with respect to symptoms and other aspects of QoL. Using the IPOS, we were able to measure an improvement in the quality of life in the low-threshold screening arm by a decrease of 0.67 points (95%-CI: 0.34 to 0.99) every 30 days. (p

The primary aim of institutional learning outcomes assessment is the creation of a culture of assessment where faculty use evidence-based data to validate and improve teaching and learning for the benefit of students. Faculty are key to these processes and yet, they are often woefully disengaged from them. This paper presents findings from an action research project that utilized a collaborative self-study approach to engage faculty in the strategic assessment of institutional learning (SAIL). SAIL is an immersive professional development opportunity that bridged quality assurance with meaningful improvements in the classroom. Findings indicated that cross-disciplinary dialogue about assessment increased faculty awareness of the (mis)alignment between course, program, and institutional learning aims while also identifying and informing potential gaps in curriculum and program design. SAIL is an excellent mechanism to engage faculty in an immersive assessment of student achievement that may then lead to meaningful improvement in teaching and learning.

This study aims to determine how using an active learning model based on the three higher education principles can improve students' active learning. Qualitative research methods were applied in this study, with data collection through interviews, literature study, and observation. The results showed that active learning based on the three higher education principles was included in the "good" or "acceptable" category. The application of this model can make this campus a place with a positive academic atmosphere that enhances and supports collaboration, discussion, and positive and critical thinking. The novelty of this research lies in the use of active learning with mini-research projects, which are developed based on university principles and embody it. The hope is that this can help solve problems in the student learning process at the State Islamic University Sunan Kalijaga, Yogyakarta, Indonesia. The expected implication is that the university's policy supports applying the model to resolve learning problems and build real scientists for students.

Students attracted to quantitative disciplines of study can be reluctant to devote much attention to the critical task of communicating, and previous research (Hostager, 2018) has identified statistically significant differences in learning approaches by major among undergraduate business students. This paper presents results of learning assurance for writing skills (direct measures) even when the course content relates to the highly quantitative topics of data analytics and finance. The approach combines various pedagogical methods in an undergraduate, writing-intensive setting: traditional testing in an iterative framework, "flipped classroom" intensive work using spreadsheet software, repeated submission of brief papers incorporating analytical finance work, and student research presentations (including at an undergraduate research conference). We present quantitative and qualitative data demonstrating assurance of learning for evaluation purposes, including the recently announced (2020) competency-based Assurance of Learning standards from the Association for the Advancement of Collegiate Schools of Business (AACSB). To assess the robustness of our findings, we also report results using alternate learning resources (old and new) and delivery methods (in-person, hybrid, fully online), taking advantage of the pandemic natural experiment. We found that learning progress was assured in each context for hybrid and fully online delivery; however, learning was not as monotonic as for fully in-person implementation.

Abstract Non‐forest ecosystems, dominated by shrubs, grasses and herbaceous plants, provide ecosystem services including carbon sequestration and forage for grazing, and are highly sensitive to climatic changes. Yet these ecosystems are poorly represented in remotely sensed biomass products and are undersampled by in situ monitoring. Current global change threats emphasize the need for new tools to capture biomass change in non‐forest ecosystems at appropriate scales. Here we developed and deployed a new protocol for photogrammetric height using unoccupied aerial vehicle (UAV) images to test its capability for delivering standardized measurements of biomass across a globally distributed field experiment. We assessed whether canopy height inferred from UAV photogrammetry allows the prediction of aboveground biomass (AGB) across low‐stature plant species by conducting 38 photogrammetric surveys over 741 harvested plots to sample 50 species. We found mean canopy height was strongly predictive of AGB across species, with a median adjusted R2 of 0.87 (ranging from 0.46 to 0.99) and median prediction error from leave‐one‐out cross‐validation of 3.9%. Biomass per‐unit‐of‐height was similar within but different among, plant functional types. We found that photogrammetric reconstructions of canopy height were sensitive to wind speed but not sun elevation during surveys. We demonstrated that our photogrammetric approach produced generalizable measurements across growth forms and environmental settings and yielded accuracies as good as those obtained from in situ approaches. We demonstrate that using a standardized approach for UAV photogrammetry can deliver accurate AGB estimates across a wide range of dynamic and heterogeneous ecosystems. Many academic and land management institutions have the technical capacity to deploy these approaches over extents of 1–10 ha−1. Photogrammetric approaches could provide much‐needed information required to calibrate and validate the vegetation models and satellite‐derived biomass products that are essential to understand vulnerable and understudied non‐forested ecosystems around the globe.