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Context: Humans constantly respond to environmental stressors challenging their somatic stability. Allostasis, an evolved neuroendocrine/physiological stressor response system, is our main pathway for doing so. Effective allostasis returns somatic systems to their current optima; over a lifetime of stressor responses, related systems fail, effectiveness declines, and physiological dysregulation (i.e. allostatic load) increases. Global Climate Change (GCC) multiplies environmental stressors on human populations and is likely to increase allostatic load. Objectives: As a population-level stressor, GCC increases risks for multiple stressors, including sociocultural instability and food and water insecurity, while also motivating migration. We predict GCC increases risk for elevated allostatic load. Here, we review pathways by which GCC increases climatic and social stressors contributing to greater stress and allostatic load. Methods: Based upon published sources and primary ethnographic case studies, this review examines how GCC, by multiplying climate-related stressors, likely increases social instability, food and water insecurity, and migration. Thereby, it is proposed that GCC contributes to allostatic load. Results: GCC multiplies stressors on local populations. Those experiencing social insecurity related to GCC during growth and development are expected to show the largest influences on their lifetime allostatic load. Similarly, as GCC increases food and water insecurity, it likely will increase allostatic load in those affected and is likely to propel migrants to seek improved living circumstances. These stressors may be continued among their descendants via historical trauma or epigenetic responses. Conclusion: GCC accentuates effects of environmental and sociocultural stressors on human populations. Those exposed to GCC are likely to show lifelong elevated allostatic load. [ABSTRACT FROM AUTHOR]

Smart factories are complex; with the increased complexity of employed cyber-physical systems, the complexity evolves further. Cyber-physical systems produce high amounts of data that are hard to capture and challenging to analyze. Real-time recording of all data is not possible due to limited network capabilities. Limited network capabilities are the reason for a chain of faults introduced via active surveillance during fault diagnosis. These introduced faults may slow down production or lead to an outage of the production line. Here, we present a novel approach to automatically select production-relevant shop floor parameters to decrease the number of surveyed variables and, at the same time, maintain quality in fault diagnosis without overloading the network. We were able to achieve higher throughput, mitigate communication losses and prevent the disruption of factory instructions. Our approach uses an autoencoder ensemble via minority voting to differentiate between normal—always on—variables and production variables that may yield a higher entropy. Our approach has been tested in a production-equal smart factory and was cross-validated by a domain expert.

Introduction: Adverse events from surgical interventions are common. They can occur at various stages of surgical care, and they carry a heavy burden on the different parties involved. While extensive research and efforts have been made to better understand the etiologies of postoperative complications, more research on intraoperative adverse events (iAEs) remains to be done., Methods: In this article, we reviewed the literature looking at iAEs to discuss their risk factors, their implications on surgical care, and the current efforts to mitigate and manage them., Results: Risk factors for iAEs are diverse and are dictated by patient-related risk factors, the nature and complexity of the procedures, the surgeon's experience, and the work environment of the operating room. The implications of iAEs vary according to their severity and include increased rates of 30-day postoperative morbidity and mortality, increased length of hospital stay and readmission, increased care cost, and a second victim emotional toll on the operating surgeon., Conclusions: While transparent reporting of iAEs remains a challenge, many efforts are using new measures not only to report iAEs but also to provide better surveillance, prevention, and mitigation strategies to reduce their overall adverse impact., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Hydrogeological information about an aquifer is difficult and costly to obtain, yet essential for the efficient management of groundwater resources. Transferring information from sampled sites to a specific site of interest can provide information when site-specific data is lacking. Central to this approach is the notion of site similarity, which is necessary for determining relevant sites to include in the data transfer process. In this paper, we present a data-driven method for defining site similarity. We apply this method to selecting groups of similar sites from which to derive prior distributions for the Bayesian estimation of hydraulic conductivity measurements at sites of interest. We conclude that there is now a unique opportunity to combine hydrogeological expertise with data-driven methods to improve the predictive ability of stochastic hydrogeological models., (© 2022 The Authors. Groundwater published by Wiley Periodicals LLC on behalf of National Ground Water Association.)

The COVID-19 Vaccines Global Access Facility (COVAX) represents an unprecedented global collaboration facilitating the development and distribution of vaccines for COVID-19. COVAX pools and channels funds from state and non-state actors to promising vaccine candidates, and has started to distribute successful candidates to participating states. The WHO, one of the leaders of COVAX, recognised vaccine doses would initially be scarce, and therefore, prepared a two-staged allocation mechanism they considered fair. In the first stage, vaccine doses are distributed equally among participating countries, while in the second stage vaccine doses will be allocated according to a country's need. Ethicists have questioned whether this is the fairest distribution-they argue a country's need should be taken into account from the start and correspondingly, have proposed a framework that treats individuals with equal moral concern, aims to minimise harm and gives priority to the worst-off. In this paper, we seek to explore these concerns by comparing COVAX's allocation mechanism to a targeted allocation based on need. We consider which distribution would more likely maximise well-being and align with principles of equity. We conclude that although in theory, a targeted distribution in proportion to a country's need would be more morally justifiable, when political realities are taken into account, an equal distribution seems more likely to avert a greater number of deaths and reduce disparities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

SARS-CoV-2 coronavirus emerged in the world at the end of 2019. The introduction of a number of restrictions had a significant effect on numerous aspects of human life with particular influence being exerted on pregnant women and their sense of security. The study aimed to assess the level of anxiety and its main determinants in women in the third trimester of pregnancy during the coronavirus pandemic. The study technique included the present purposely designed questionnaire, Labor Anxiety Questionnaire (KLPII), and the State-Trait Anxiety Inventory (STAI). The study was conducted in a group of 315 women in the third trimester of pregnancy. A total of 258 women (81.9%) completed the questionnaire in May 2020, and 57 of them (18.1%) completed it in October 2020. The overall analysis of the Labor Anxiety Questionnaire and the STAI inventory revealed a high level of anxiety, particularly situational anxiety, in pregnant women during the SARS-CoV-2 pandemic. The age and financial status of the women were the factors which contributed to the intensification of tokophobia. Women interviewed in October 2020 were characterized by higher tokophobia levels compared to the respondents included in May 2020. It seems justified to in-crease the vigilance in the diagnostics of possible mental disorders in the perinatal period during pandemic.

Onychomycosis is a challenging nail condition to treat. The gold standard treatment relies on long-term systemic therapy, which carries risks of potential side effects and drug interactions. Topical alternatives exist; however, treatment outcomes remain disappointing. In this article, we review newer topical formulations that are approved by the United States Food and Drug Administration, as well as other topical drugs that are still undergoing clinical trials. Lasers and energy-based devices have also been used for the treatment of onychomycosis; however, standardized parameters and clear treatment endpoints have yet to be specified. Currently, device-based therapies are considered as options for improving the cosmetic appearance of nails. The use of lasers to improve the penetration of topical antifungal treatments as possible combination treatments is also reviewed., Competing Interests: FUNDING:No funding was provided for this study. DISCLOSURES:The authors have no conflicts of interest relevant to the content of this article., (Copyright © 2019. Matrix Medical Communications. All rights reserved.)

At Tenri Hospital in Nara prefecture of Japan, the blood culture system is managed by a medical technologist with a microbiology specialty, and the other medical technologists manage the blood culture system when the primary technologist who specializes in microbiology is not working in 24 hours. For positive cultures, the Gram staining morphology of the organism is reported direct by to the clinician by telephone within 24 hours after culture bottles are submitted to the laboratory. We, the medical technologist, discuss with the clinician the focus of infection, use of antibiotics, effects of antimicrobial therapy, and clinical background of the patient. In some cases, we examine the MICs of specific bacteria isolated from patients and calculate the pharmacokinetic (PK)/pharmacodynamic (PD) parameters(e.g., time above the MIC, area under the curve/MIC and peak concentration/MIC). We then recommend to the clinician the most suitable dosage regimen. For patients with a serious infection or renal failure requiring a special dosing regimen, we perform therapeutic-drug monitoring with various antimicrobial agents. Information for rapid diagnosis of bacteremia and suitable dosing regimens for antimicrobial agents should be provided to the clinician with the following considerations: (1)findings should be reported within 24 hours of receiving a specimen, (2)the report should include a therapeutic regimen that considers the MIC of the target bacteria, and (3)the MIC interpretive criteria that correspond to the dosage regimen should be adopted.

An extreme dwarf 10-year-old boy was described. His clinical features resemble those of isolated GH deficiency type 1A, but the Southern blot analysis showed no gross deletion in the GH structural gene. Endocrinological evaluations showed severe GH and PRL deficiencies, and mild TSH deficiency. The simultaneous deficiencies of anterior pituitary hormones in our patient resemble those of the Snell and Ames dwarf mice and suggest a common etiology. The evolutionary and embryological similarities between GH and PRL imply that mutations at a gene which controls GH and PRL production in somatotropes and lactotropes or at a gene of which product affects the embryological development from a common ancestral cell in the anterior pituitary gland may be a primary defect in our patient.

SEM was used to visualize the normal postnatal development of the neonatal rat neuromuscular junction (nmj). Maturational changes evoked by ACTH/MSH 4-10 (10 micrograms/kg/day IP) or ACTH/MSH 4-9 (Org 2766) (0.01 microgram/kg/day IP) were compared to controls and to pups treated with nicotine during prenatal and postnatal life, or only during the gestation period. Pregnant females received 0.25 mg/kg 2X daily IP; neonates 0.05 mg/kg/day SC. The Desaki and Uehara and Fahim et al. methods revealed the nmj on the extensor digitorum muscle to be covered by a delicate drapery of postjunctional folds that surround the immature endplate region. By the second week of postnatal life, these folds become more complex and cover a larger area. Upon maturation the folds descend and invaginate into the muscle fiber. Peptide treatment with either ACTH/MSH 4-10 or ACTH/MSH 4-9 accelerates maturation of the endplate as demonstrated by the increased convolutions of the folds. Similar effects follow nicotine administration. The observed changes in morphology of the developing nmj subjected to nicotine may be mediated through nicotine-evoked ACTH release.