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Here, we highlight 35 global researchers approximately under the age of 35. This third annual cohort was self-generated by initial seed invitations sent by the editorial team, with each contributor suggesting two more in a nominally supervised self-selecting pyramid-like scheme. The final collection reflects both the diversity and excitement across the field of materials science.

IMPORTANCE: The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain. OBJECTIVE: To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries. DESIGN, SETTING, AND PARTICIPANTS: Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023. EXPOSURES: Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers. MAIN OUTCOMES AND MEASURES: The proportion of children who met the World Health Organization guidelines for physical activity (≥180 min/d of total physical activity and ≥60 min/d of moderate- to vigorous-intensity physical activity), screen time (≤1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis. RESULTS: Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle–income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle–income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8). CONCLUSIONS AND RELEVANCE: Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.

Background/AimsPersonalised care is associated with high-quality, safe maternity care. Limited evidence exists on midwives' perception of personalised care and potential barriers and facilitators associated with implementing it in practice. The aim of this study was to explore midwives' perspectives of personalised care.MethodsAn online mixed-methods survey was conducted exploring the perspectives of 46 NHS midwives. Data were analysed using descriptive statistics and thematic analysis.ResultsAssessing individual needs was perceived as a key facilitator and time restrictions were considered a significant barrier to providing personalised care in practice.ConclusionsProviding personalised care is associated with increased job satisfaction for midwives, and key barriers include inflexible healthcare systems and limited resources.Implications for practiceThe findings contribute to an understanding of the factors that influence the provision of personalised care and have the potential to inform improvements in maternity services.

IMPORTANCE: The indications, safety, and efficacy of chemical venous thromboembolism prophylaxis (cVTE) in pediatric trauma patients remain unclear. A set of high-risk criteria to guide cVTE use was recently recommended; however, these criteria have not been evaluated prospectively. OBJECTIVE: To examine high-risk criteria and cVTE use in a prospective multi-institutional study of pediatric trauma patients. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was completed between October 2019 and October 2022 in 8 free-standing pediatric hospitals designated as American College of Surgeons level I pediatric trauma centers. Participants were pediatric trauma patients younger than 18 years who met defined high-risk criteria on admission. It was hypothesized that cVTE would be safe and reduce the incidence of VTE. EXPOSURES: Receipt and timing of chemical VTE prophylaxis. MAIN OUTCOMES AND MEASURES: The primary outcome was overall VTE rate stratified by receipt and timing of cVTE. The secondary outcome was safety of cVTE as measured by bleeding or other complications from anticoagulation. RESULTS: Among 460 high-risk pediatric trauma patients, the median (IQR) age was 14.5 years (10.4-16.2 years); 313 patients (68%) were male and 147 female (32%). The median (IQR) Injury Severity Score (ISS) was 23 (16-30), and median (IQR) number of high-risk factors was 3 (2-4). A total of 251 (54.5%) patients received cVTE; 62 (13.5%) received cVTE within 24 hours of admission. Patients who received cVTE after 24 hours had more high-risk factors and higher ISS. The most common reason for delayed cVTE was central nervous system bleed (120 patients; 30.2%). There were 28 VTE events among 25 patients (5.4%). VTE occurred in 1 of 62 patients (1.6%) receiving cVTE within 24 hours, 13 of 189 patients (6.9%) receiving cVTE after 24 hours, and 11 of 209 (5.3%) who had no cVTE (P = .31). Increasing time between admission and cVTE initiation was significantly associated with VTE (odds ratio, 1.01; 95% CI, 1.00-1.01; P = .01). No bleeding complications were observed while patients received cVTE. CONCLUSIONS AND RELEVANCE: In this prospective study, use of cVTE based on a set of high-risk criteria was safe and did not lead to bleeding complications. Delay to initiation of cVTE was significantly associated with development of VTE. Quality improvement in pediatric VTE prevention may center on timing of prophylaxis and barriers to implementation.

Photoredox catalysis is a powerful tool to access challenging and diverse syntheses. Absorption of visible light forms the excited state catalyst (*PC) but photons may be wasted if one of several unproductive pathways occur. Facile dissociation of the charge-separated encounter complex [PC•–:D•+], also known as (solvent) cage escape, is required for productive chemistry and directly governs availability of the critical PC•–intermediate. Competitive charge recombination, either inside or outside the solvent cage, may limit the overall efficiency of a photochemical reaction or internal quantum yield (defined as the moles of product formed per mole of photons absorbed by PC). Measuring the cage escape efficiency (ϕCE) typically requires time-resolved spectroscopy; however, we demonstrate how to estimate ϕCEusing steady-state techniques that measure the efficiency of PC•–formation (ϕPC). Our results show that choice of electron donor critically impacts ϕPC, which directly correlates to improved synthetic and internal quantum yields. Furthermore, we demonstrate how modest structural differences between photocatalysts may afford a sizable effect on reactivity due to changes in ϕPC, and by extension ϕCE. Optimizing experimental conditions for cage escape provides photochemical reactions with improved atom economy and energy input, paving the way for sustainable design of photocatalytic systems.

Background:People with intellectual disabilities (ID) experience many health and social inequalities. Increasing physical activity is a proven intervention to address such inequalities, yet the physical activity rates of this population are substantially lower than the general population.Aim:Research has been growing to understand why this is and how to intervene to increase the physical activity levels of people with ID.Method:Using a behavioural epidemiological framework, the research in this area from barriers and facilitators of physical activity to translational research testing interventions within natural settings is reviewed. Findings from a total of 14 reviews and eight empirical studies and protocols were included.Results:Whilst there are multiple investigations into what promotes or enhances physical activity for people with ID, findings from intervention studies show few successful outcomes. Gaps within the existing research are identified and recommendations about how intervention efficacy might be improved are provided to inform future research and practice.Conclusion:Findings from previous research on barriers and facilitators can be further capitalised on and intervention studies should be underpinned by better links to theory and more systemic approaches.

Nucleic acid nanoparticles (NANPs) are increasingly used in preclinical investigations as delivery vectors. Tools that can characterize assembly and assess quality will accelerate their development and clinical translation. Standard techniques used to characterize NANPs, like gel electrophoresis, lack the resolution for precise characterization. Here, we introduce the use of charge detection mass spectrometry (CD-MS) to characterize these materials. Using this technique, we determined the mass of NANPs varying in size, shape, and molecular mass, NANPs varying in production quality due to formulations lacking component oligonucleotides, and NANPs functionalized with protein and nucleic acid-based secondary molecules. Based on these demonstrations, CD-MS is a promising tool to precisely characterize NANPs, enabling more precise assessments of the manufacturing and processing of these materials.

The main capsid protein (CP) of norovirus, the leading cause of gastroenteritis, is expected to self-assemble into virus-like particles with the same structure as the wild-type virus, a capsid with 180 CPs in a T= 3 icosahedron. Using charge detection mass spectrometry (CD-MS), we find that the norovirus GI.1 variant is structurally promiscuous, forming a wide variety of well-defined structures, some that are icosahedral capsids and others that are not. The structures that are present evolve with time and vary with solution conditions. The presence of icosahedral T= 3 and T= 4 capsids (240 CPs) under some conditions was confirmed by cryo-electron microscopy (cryo-EM). The cryo-EM studies also confirmed the presence of an unexpected prolate geometry based on an elongated T= 4 capsid with 300 CPs. In addition, CD-MS measurements indicate the presence of well-defined peaks with masses corresponding to 420, 480, 600, and 700 CPs. The peak corresponding to 420 CPs is probably due to an icosahedral T= 7 capsid, but this could not be confirmed by cryo-EM. It is possible that the T= 7 particles are too fragile to survive vitrification. There are no mass peaks associated with the T= 9 and T= 12 icosahedra with 540 and 720 CPs. The larger structures with 480, 600, and 700 CPs are not icosahedral; however, their measured charges suggest that they are hollow shells. The use of CD-MS to monitor virus-like particles assembly may have important applications in vaccine development and quality control.

We present two strategies to reduce the complexity of the alternating direction method of multipliers when applied to linear programming (ADMM-LP) decoding of low-density parity-check codes. First, to address the high complexity of computing a projection onto the parity polytope, the complexity bottleneck of ADMM-LP decoding, we propose the sparse affine projection algorithm (SAPA). SAPA projects onto the affine hull of $\chi \leq d$ nearby local codewords where the check degree is d and where $\chi $ can be significantly smaller than d. Unlike exact projection, SAPA does not require a water-filling process, and thus can be implemented with lower per-iteration complexity. Second, to reduce the number of effective iterations needed for ADMM-LP decoding, we propose a randomized layered scheduling framework. Rather than updating checks in round-robin fashion in each iteration, more “problematic” checks have a higher probability of being updated. The probability mass function that governs the selection of which checks to update is based upon the location of replica vectors inside (or on) the parity polytope. The resultant decoder converges significantly faster under this randomized scheduling than under round-robin scheduling. This makes it well suited for use in applications that limit the number of iterations.

Eliciting an antihapten antibody response to vaccination typically requires the use of constructs where multiple copies of the hapten are covalently attached to a larger carrier molecule. The carrier is required to elicit T cell help via presentation of peptide epitopes on major histocompatibility complex (MHC) class II molecules; as such, attachment to full-sized proteins, alone or in a complex, is generally used to account for the significant MHC diversity in humans. While such carrier-based vaccines have proven extremely successful, particularly in protecting against bacterial diseases, they can be challenging to manufacture, and repeated use can be compromised by pre-existing immunity against the carrier. One approach to reducing these complications is to recruit help from type I natural killer T (NKT) cells, which exhibit limited diversity in their antigen receptors and respond to glycolipid antigens presented by the highly conserved presenting molecule CD1d. Synthetic vaccines for universal use can, therefore, be prepared by conjugating haptens to an NKT cell agonist such as α-galactosylceramide (αGalCer, KRN7000). An additional advantage is that the quality of NKT cell help is sufficient to overcome the need for an extra immune adjuvant. However, while initial studies with αGalCer-hapten conjugate vaccines report strong and rapid antihapten antibody responses, they can fail to generate lasting memory. Here, we show that antibody responses to the hapten 4-hydoxy-3-nitrophenyl acetyl (NP) can be improved through additional attachment of a fusion peptide containing a promiscuous helper T cell epitope (Pan DR epitope, PADRE) that binds diverse MHC class II molecules. Such αGalCer-hapten-peptide tricomponent vaccines generate strong and sustained anti-NP antibody titers with increased hapten affinity compared to vaccines without the helper epitope. The tricomponent vaccine platform is therefore suitable for further exploration in the pursuit of efficacious antihapten immunotherapies.

The ways in which we think about and refer to people with disabilities has changed considerably over the years; the terminology and educational strategies used continue to evolve. It is important for music teachers to stay well-informed on the latest research, labels being used, and best practice, especially when working with students with disabilities in inclusive music classrooms. This article provides guidance for music educators on staying well-informed, along with recommendations for researchers concerning students with disabilities.

Due to low compliance by bedside nursing with a central line-associated bloodstream infection (CLABSI) prevention bundle and increased CLABSI rates, a mandatory re-education initiative at a 1200-bed university-affiliated hospital was undertaken. Despite this, 2 units, housing high-risk immunocompromised patients, continued to experience increased CLABSI rates. A quality improvement before-after project design in these units replaced bedside nursing staff with 2 nurses from the vascular access team (VAT) to perform central vascular access device (CVAD) dressing changes routinely every 7 days or earlier if needed. The VAT consistently followed the bundled components, including use of chlorhexidine gluconate (CHG)-impregnated dressings on all patients unless an allergy was identified. In this case, a non-CHG transparent semipermeable membrane dressing was used. There were 884 patients with 14 211 CVAD days in the preimplementation period and 1136 patients with 14 225 CVAD days during the postimplementation period. The VAT saw 602 (53.0%) of the 1136 patients, performing at least 1 dressing change in 98% of the patients (n = 589). The combined CLABSI rate for the 2 units decreased from 2.53 per 1000 CVAD days preintervention to 1.62 per 1000 CVAD days postintervention. The estimated incidence rate ratio (IRR) for the intervention was 0.639, a 36.1% reduction in monthly CLABSI rates during the postimplementation period.

The article provides information about the natural and historical features of Lee and Ogle counties in Illinois. It mentions the presence of Indigenous peoples in the area and the conflicts that occurred during the French and Iroquois Wars. The counties are known for their Rock River Hill Country and Grand Prairie biosystem, which support a diverse range of animals. The article highlights specific locations such as Lowden State Park, Castle Rock State Park, and the Blackhawk Area Council Camp, and emphasizes the opportunities for outdoor activities like hiking, canoeing, kayaking, and camping. It also mentions the A. E. Staley Manufacturing Company and its founder, A. E. Staley. Overall, the text provides a collection of information about hiking sites in Illinois, focusing on their natural beauty and historical significance. [Extracted from the article]

En esta entrevista, Colectivo LASTESIS reflexiona sobre la historia del colectivo y la comprensión de la performance feminista como una forma de expandir y hacer más accesibles diferentes teorías feministas. Enfatizando la centralidad del cuerpo, hablan sobre la relevancia de pasar las ideas por los cuerpos concretos, lo que implica la capacidad de buscar diferentes dimensiones de pensamiento y textualidad, como sonido, color y textura, así como también de conectar con todo un archivo que ha resistido siglos de colonialismo. En este sentido, ubican su obra dentro de una larga historia de performance, haciendo visible la continuidad entre múltiples archivos que problematizaron diferentes formas de colonialismo y opresión, haciendo legible diferentes formas creativas de resistencia.

In this interview, Colectivo LASTESIS reflects on the history of the collective and their understanding of feminist performance as a way of expanding different feminist theories and making them more accessible. Emphasizing the centrality of the body, they speak about the importance of moving ideas through concrete bodies. This requires the capacity to deploy different dimensions of both thought and textuality, such as sound, color, and texture, as well as to connect to an archive that has resisted centuries of colonialism. In this sense, the collective locates their work within a long history of performance, making visible the continuity between multiple archives that problematize different forms of colonialism and oppression, and making legible different creative forms of resistance.

IMPORTANCE: Opioid analgesics may be associated with increased risk of falls, particularly among older adults. OBJECTIVE: To quantify the age-related risk of serious fall events among adults prescribed opioids by opioid exposure, time from initiation, and daily dose. DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study conducted in New South Wales, Australia, used data linking national pharmaceutical claims to national and state datasets, including information on sociodemographic characteristics, clinical characteristics, medicines use, health services utilization, and mortality (POPPY II study). It included adults (18 years or older) who initiated prescription opioid treatment, which was defined as no prior dispensing during the preceding 365 days, between January 1, 2005, and December 31, 2018. Data were analyzed from February to June 2023. EXPOSURE: Time-dependent periods of opioid exposure were evaluated from dispensing records. MAIN OUTCOME AND MEASURES: Serious fall events identified from emergency department, hospitalization, and mortality records. Negative binomial models were used to assess associations between time-dependent opioid exposure (overall, by time from initiation, and by dose), age, and risk of fall events. Models were adjusted for known fall risk factors, including other fall risk–increasing drugs, frailty risk, and prior serious fall events. RESULTS: The cohort comprised 3 212 369 individuals who initiated prescription opioid treatment (1 702 332 women [53%]; median [IQR] age at initiation, 49 [32-65] years). Overall, 506 573 serious fall events were identified, including 5210 fatal falls. During exposure to opioids, the risk of serious fall events was elevated among all age groups; compared with the group aged 18 to 44 years, this risk was highest among those 85 years or older (adjusted incident rate ratio, 6.35; 95% CI, 6.20-6.51). Across all age groups, the first 28 days following opioid initiation was a time of increased serious fall risk; this risk increased with age. Among individuals aged 18 to 84 years, associations were identified between higher daily opioid doses and serious fall events. CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that prescription opioids were associated with increased risk of serious fall events among adults of all ages, with individuals 85 years or older at greatest risk. These risks should be considered when prescribing opioids, particularly for individuals with preexisting risk factors or when opioids are prescribed at higher doses. Targeted falls prevention efforts may be most effective within the first month following opioid initiation.

ABSTRACTMild traumatic brain injury (mTBI) occurs from biomechanical forces on the brain, leading to pathophysiological changes that cause cognitive, perceptual, and/or motor impairments. Following mTBI, individuals are likely to be concerned about preventing pain or re-injury, therefore, we asked whether they had greater propensity to consciously monitor and control their movements. We also examined whether an association exists between the propensity to consciously monitor and control movements and mTBI clinical factors (time since most recent mTBI, number of mTBI, symptom severity). 157 participants with mTBI and 188 controls completed the Movement Specific Reinvestment Scale (MSRS) to measure the propensity for conscious monitoring and control of movements (i.e., movement specific reinvestment). Multivariate analysis of variance was used to explore scores on the MSRS as a function of mTBI/control and males/females with and without history of mTBI. Compared to controls, people with mTBI scored higher on both MSRS sub-scales (conscious motor processing, movement self-consciousness). Irrespective of mTBI history, females scored higher on the movement self-consciousness sub-scale. Multiple regression analyses were conducted to examine relationships between movement specific reinvestment and mTBI clinical factors. Time since most recent mTBI was negatively associated with conscious motor processing, suggesting that during early stages of recovery, people with mTBI are more likely to consciously control their movements. No association was evident between movement specific reinvestment and number of mTBI or symptom severity. Further understanding the relationship between conscious motor processes and mTBI may help tailor rehabilitation strategies to meet individual needs of those with mTBI.

This article provides a comprehensive overview of the historical and recreational significance of Sangamon County and Lincoln Country in Illinois. It focuses on Abraham Lincoln's connection to Springfield and his travels throughout the state. The authors share their personal experiences exploring Lincoln's home and other historical sites in the area, including downtown Springfield and Oak Ridge Cemetery. They also mention the Lincoln Log Cabin site near Charleston as a potential destination for future exploration. The article emphasizes the importance of planning a visit to these sites and suggests allowing ample time to fully appreciate the history and culture of the area. Additionally, the text mentions various other historic and natural sites in Illinois that library patrons can visit for research purposes, such as Lincoln's New Salem State Historic Site, the Lincoln Memorial Garden & Nature Center, Oak Ridge Cemetery, and the Mary Todd Lincoln House in Lexington, Kentucky. It also highlights opportunities for hiking and observing nature in locations like Carpenter's Park and the Margery Adams Wildlife Sanctuary. [Extracted from the article]

This report investigates the mechanism of photochemical Povarov-type reactions of N,N-dialkylanilines and maleimides in polar solvents (DMF or dioxane) in the presence of light. Fundamental aspects of the electron donor–acceptor (EDA) photoactivation pathway proposed to underpin this chemistry are examined through integrated experimental and computational studies. This approach provided evidence supporting the involvement of an EDA complex in facilitating this chemistry via a reaction mechanism that does not involve a triplet manifold. Most notably, our findings indicate that relying solely on UV–vis absorption spectroscopic data to either account for or predict reactivity in synthetic experiments may not always provide the complete picture. More specifically, this relates to considering UV–vis absorption spectroscopic data, calculated values for association constants (KEDA) and molar extinction coefficients (ε), with the reactivity observed in associated synthetic reactions in practice.

The optimal target for systemic oxygenation in critically ill children is unknown. Liberal oxygenation is widely practiced, but has been associated with harm in paediatric patients. We aimed to evaluate whether conservative oxygenation would reduce duration of organ support or incidence of death compared to standard care.

Trees structure the Earth’s most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations1–6in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth’s 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world’s most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees.

The symptoms of malaria occur during the blood stage of infection, when parasites invade and replicate within human erythrocytes. The PfPCRCR complex1, containing PfRH5 (refs. 2,3), PfCyRPA, PfRIPR, PfCSS and PfPTRAMP, is essential for erythrocyte invasion by the deadliest human malaria parasite, Plasmodium falciparum. Invasion can be prevented by antibodies3–6or nanobodies1against each of these conserved proteins, making them the leading blood-stage malaria vaccine candidates. However, little is known about how PfPCRCR functions during invasion. Here we present the structure of the PfRCR complex7,8, containing PfRH5, PfCyRPA and PfRIPR, determined by cryogenic-electron microscopy. We test the hypothesis that PfRH5 opens to insert into the membrane9, instead showing that a rigid, disulfide-locked PfRH5 can mediate efficient erythrocyte invasion. We show, through modelling and an erythrocyte-binding assay, that PfCyRPA-binding antibodies5neutralize invasion through a steric mechanism. We determine the structure of PfRIPR, showing that it consists of an ordered, multidomain core flexibly linked to an elongated tail. We also show that the elongated tail of PfRIPR, which is the target of growth-neutralizing antibodies6, binds to the PfCSS–PfPTRAMP complex on the parasite membrane. A modular PfRIPR is therefore linked to the merozoite membrane through an elongated tail, and its structured core presents PfCyRPA and PfRH5 to interact with erythrocyte receptors. This provides fresh insight into the molecular mechanism of erythrocyte invasion and opens the way to new approaches in rational vaccine design.

The burden of malnutrition experienced globally, coupled with the increasing rate of micronutrient deficiencies, compromises the health and well-being of women during their reproductive years. Obesity places young South African women at particular risk during pregnancy, and increases obesity risk for their offspring. To address these risks, the Bukhalitrial is being implemented in Soweto, South Africa with 18–28-year-old women, as part of the Healthy Lifestyle Trajectory Initiative. A dietitian is part of the Bukhaliintervention team (community health workers) to provide nutritional support for overweight/obese trial participants, making use of the International Federation of Gynaecology and Obstetrics (FIGO) Nutrition Checklist. This paper reflects on the experiences and lessons learned by the Bukhalidietitian, including the use of the FIGO Nutrition Checklist and Healthy Conversation Skills to facilitate conversations about making healthy dietary behaviour changes. Identified challenges that influence nutrition and behaviour are discussed, including lack of food affordability, cultural and social influences on healthy food choices, unsupportive environments and food insecurity. Strategies to optimise this nutritional support are also mentioned. The Bukhalitrial is showing that introducing additional nutrition support by a dietitian for at-risk participants has the potential to encourage young women to prioritise nutrition and health, even in the midst of contextual challenges to both nutrition and health.

Fusion energy could be a part of sustainable energy development from approximately 2050. However, the international community does not possess a coherent global roadmap for managing fusion's global development from the science-oriented ITER phase, the 2020s–2030s, into the energy-oriented demonstration power plant (DEMO) phase of demonstration fusion pilot plants (FPPs), the 2030s–2040s, nor a plan to scale up from the first working FPPs to second-generation fleets of devices. In this article, we propose an existing mechanism, an International Energy Agency-Backed North–South Global Commission, as a management-focusing device. It suggests that, in addition to incorporating practices in commission design that facilitate them in producing useful evidence and recommending actions, commission construction should reflect the analytic power of the quintuple innovation helix model to arm it with deep democratic engagement across different domains. This ensures that the commission's design, including membership and staffing, will facilitate the multistakeholder participation and deliberation needed to both form a management environment for fusion development and for supporting and accelerating the financial, technological, and other intersectoral and inter-regional (North/South) commitments. These are essential to incorporate fusion into a sustainable global energy future by 2100, significantly contributing to the energy transition. This approach also offers recommendations for future international commission design across different management domains.

In the United States, approximately 11.8% of students receiving special education are Emergent Bilingual (EB) students (Office of Special Education Programs [OSEP], 2022). Emergent bilingual students are frequently referred to as English Learners (ELs) or Limited English Proficient (LEP) students which portray them through a deficit lens and disregards their home language and cultural knowledge. Instead, EB students should be portrayed through an asset-based lens, as they are simultaneously acquiring skills in both English and their home language (Garcia et al., 2008; Poza, 2017). Emergent bilingual students qualify for special education, at least in part, due to the challenges differentiating language acquisition from learning disability. Few evidence-based interventions are available for EB students and when coupled, these factors affect the accuracy of identification and equitable access to education. The purpose of this survey was to gather the perspectives of school psychologists on the Central Coast of California and understand the extent to which best practices for EB students are implemented through Multi-Tiered Systems of Support (MTSS). The findings suggest areas of strength and areas of improvement in the implementation of these practices which can offer valuable insights into the “on-the-ground” implementation in Central Coast schools.

ObjectiveNeonatal infection with wildtype SARS-CoV-2 is rare and good outcomes predominate. We investigated neonatal outcomes using national population-level data to describe the impact of different SARS-CoV-2 variants.DesignProspective population-based cohort study.SettingNeonatal, paediatric and paediatric intensive care inpatient care settings in the UK.PatientsNeonates (first 28 days after birth) with confirmed SARS-CoV-2 infection who received inpatient care, March 2020 to April 2022. Neonates were identified through active national surveillance with linkage to national SARS-CoV-2 testing data, routinely recorded neonatal data, paediatric intensive care data and obstetric and perinatal mortality surveillance data.OutcomesPresenting signs, clinical course, severe disease requiring respiratory support are presented by the dominant SARS-CoV-2 variant in circulation at the time.Results344 neonates with SARS-CoV-2 infection received inpatient care; breakdown by dominant variant: 146 wildtype, 123 alpha, 57 delta and 18 omicron. Overall, 44.7% (153/342) neonates required respiratory support; short-term outcomes were good with 93.6% (322/344) of neonates discharged home. Eleven neonates died: seven unrelated to SARS-CoV-2 infection, four were attributed to neonatal SARS-CoV-2 infection (case fatality 4/344, 1.2% 95% CI 0.3% to 3.0%) of which three were born preterm due to maternal COVID-19. More neonates were born very preterm (23/54) and required invasive ventilation (27/57) when delta variant was predominant, and all four SARS-CoV-2-related deaths occurred in this period.ConclusionsInpatient care for neonates with SARS-CoV-2 was uncommon. Although rare, severe neonatal illness was more common during the delta variant period, potentially reflecting more severe maternal disease and associated preterm birth.Trial registration numberISRCTN60033461.

ObjectiveSurvival of babies born very preterm (<32 weeks gestational age) has increased, although preterm-born children may have ongoing morbidity. We aimed to investigate the risk of admission to paediatric intensive care units (PICUs) of children born very preterm following discharge home from neonatal care.DesignRetrospective cohort study, using data linkage of National Neonatal Research Database and the Paediatric Intensive Care Audit Network datasets.SettingAll neonatal units and PICUs in England and Wales.PatientsChildren born very preterm between 1 January 2013 and 31 December 2018 and admitted to neonatal units.Main outcome measuresAdmission to PICU after discharge home from neonatal care, before 2 years of age.ResultsOf the 40 690 children discharged home from neonatal care, there were 2308 children (5.7%) with at least one admission to PICU after discharge. Of these children, there were 1901 whose first PICU admission after discharge was unplanned.The percentage of children with unplanned PICU admission varied by gestation, from 10.2% of children born <24 weeks to 3.3% born at 31 weeks.Following adjustment, unplanned PICU admission was associated with lower gestation, male sex (adjusted OR (aOR) 0.79), bronchopulmonary dysplasia (aOR 1.37), necrotising enterocolitis requiring surgery (aOR 1.39) and brain injury (aOR 1.42). For each week of increased gestation, the aOR was 0.90.ConclusionsMost babies born <32 weeks and discharged home from neonatal care do not require PICU admission in the first 2 years. The odds of unplanned admissions to PICU were greater in the most preterm and those with significant neonatal morbidity.

ObjectiveTo quantify the characteristics of children admitted to neonatal units (NNUs) and paediatric intensive care units (PICUs) before the age of 2 years.DesignA data linkage study of routinely collected data.SettingNational Health Service NNUs and PICUs in England and WalesPatientsChildren born from 2013 to 2018.InterventionsNone.Main outcome measureAdmission to PICU before the age of 2 years.ResultsA total of 384 747 babies were admitted to an NNU and 4.8% (n=18 343) were also admitted to PICU before the age of 2 years. Approximately half of all children admitted to PICU under the age of 2 years born in the same time window (n=18 343/37 549) had previously been cared for in an NNU.The main reasons for first admission to PICU were cardiac (n=7138) and respiratory conditions (n=5386). Cardiac admissions were primarily from children born at term (n=5146), while respiratory admissions were primarily from children born preterm (<37 weeks’ gestational age, n=3550). A third of children admitted to PICU had more than one admission.ConclusionsHealthcare professionals caring for babies and children in NNU and PICU see some of the same children in the first 2 years of life. While some children are following established care pathways (eg, staged cardiac surgery), the small proportion of children needing NNU care subsequently requiring PICU care account for a large proportion of the total PICU population. These differences may affect perceptions of risk for this group of children between NNU and PICU teams.

ObjectivesTo determine the baseline trends in the total birth prevalence of neural tube defects (NTDs) in England (2000–2019) to enable the impact of folic acid fortification of non-wholemeal wheat flour to be monitored.DesignPopulation-based, observational study using congenital anomaly (CA) registration data for England curated by the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS).SettingRegions of England with active registration in the time period.ParticipantsBabies that were liveborn or stillborn and pregnancies that resulted in a termination of pregnancy or a late miscarriage (20–23 weeks’ gestation) with an NTD.Main outcome measuresTotal birth prevalence of anencephaly, spina bifida and all NTDs in England. Poisson regression analysis was used to evaluate time trends with regional register as a random effect. The progress of national registration across England was assessed.ResultsThere were 4541 NTD pregnancies out of 3 637 842 births in England; 1982 anencephaly and 2127 spina bifida. NTD prevalence was 12.5 (95% CI 12.1 to 12.9) per 10 000 total births. NTD prevalence per 10 000 total births was significantly higher in 2015–2019 (13.6, 95% CI 12.9 to 14.4) compared with 2010–2014 (12.1, 95% CI 11.7 to 12.5). An increasing trend in NTDs overall was detected (incidence rate ratio (IRR) 1.01, 1.00 to 1.02), although further analysis determined this effect was confined to 2015–2019 (compared against 2000–2004, IRR 1.14, 1.04 to 1.24). The birth prevalence of anencephaly reflected this pattern. The prevalence of spina bifida remained relatively stable over time.ConclusionsBaseline NTD prevalence for England has been established. National and standardised CA registration is in place, facilitating the systematic and consistent monitoring of pre-fortification and post-fortification NTD trends and evaluating the impact of fortification on NTD prevalence.

Refill friction stir spot welding is a solid-state spot-welding technique suited to lap joining of thin aluminium sheets, including difficult-to-weld 2xxx series alloys that are prone to hot cracking during fusion welding processes. Long welding time is an ongoing challenge that hinders industrial adoption of the process. To address this, the present study explores much shorter welding times than those previously reported in the literature and assesses the impact on joint quality. Joints of 1.8 mm thick AA2024-T3 sheet were produced with welding times from 3 s, down to 0.75 s and rotational speeds of 1000 rpm to 2500 rpm. Defect formations within the welds were studied with the aid of optical microscopy. The mechanical properties were evaluated using tensile lap shear testing and microhardness mapping, and failure modes were characterised using scanning electron microscopy. Various weld defects were found at all welding times and rotational speeds, and the defects enlarged with decreasing welding time and increasing RS. The highest lap shear strength of 9.21 kN was achieved with a welding time of 3 s and rotational speed of 2000 rpm; lap shear strengths of 7.02 kN and 6.37 kN were achieved for 1.5 s and 0.75 s welds, respectively.

Background:Pharmacist order verification is a critical step in ensuring medication safety for patients. While the second pharmacist verification (SPV) before dispensing anticancer therapies has been a longstanding practice, its continued necessity in the context of modern electronic health systems lacks robust evidence. Objective:This study aimed to assess the frequency of interventions performed by a second pharmacist to determine the ongoing effectiveness of the SPV process. Methods:This retrospective chart review was conducted at the Mayo Clinic, encompassing all anticancer therapy orders that necessitated an SPV. The study period extended from January 1, 2019, to June 30, 2021, and included inpatient and outpatient anticancer orders. The quantification and reporting of alterations made to discrete order fields subsequent to initial pharmacist verification of clinical significance were performed, utilizing the total number of anticancer therapy orders as the denominator. Results:Approximately 300 000 anticancer therapy orders were screened for inclusion criteria and 2.6% (N = 7634) of orders were modified on the SPV. Most changes were in the categories of rate (N = 1962), order start time (N = 1219), and pharmacy communication note (N = 777). Dosing changes greater than 10% accounted for 0.03% (N = 99) of the orders, with 10 anticancer therapies responsible for more than 50% of these changes. Conclusion and relevance:This study represents the largest report on the impact of SPV in a modern era. Our results suggest the SPV may be valuable for a small proportion of chemotherapy orders but raises questions about the necessity for broad application of this practice.

Students with disabilities may require specific assistive technology to use their strengths to compensate for a weakness or need caused by the disability, including both “devices” and “services.” As a result, teachers need to be able to use and support students while using assistive technology during instruction. Teachers also can use technology during instruction to support students with and without disabilities. This article summarizes the different types of assistive technology students may use in the inclusive music classroom as well as ways music teachers can use other technology to support students with disabilities.

Purpose: This study explores the effects of parents' attending status and alcohol consumption (scenario based) on their feelings of happiness, relaxation, family cohesion and family satisfaction. Design/methodology/approach: This study uses a 2 (attending status: with a child or without a child) X 3 (alcohol consumption: water, a cup of beer or four cups of beers) between-subjects experimental design on an art festival and employs relational cohesion theory while spillover theory. Findings: The results reveal (1) significant differences between parents' attending status on happiness and relaxation; (2) significant differences between alcohol consumption on happiness, family cohesion, and family satisfaction and (3) happiness significantly mediates the effect of parents' alcohol consumption on family cohesion and family satisfaction. Practical implications: Attending art festivals provides families with a chance to consolidate family relationships. Art festival planners could promote the festival through enhancing participants' family cohesion and satisfaction through potential family leisure activities. Originality/value: Events are an emerging topic in the hospitality and tourism discipline in recent years. Social impacts, especially family-related outcomes, on art festivals are barely examined. Additionally, while alcohol consumption is common in festivals, the influence of alcohol consumption on the attendees' emotions and behaviors is under-researched.

Background:Undergraduate nursing students spend a significant amount of time in clinical placements where they are involved in care at the end of a person's life and care after death. While their role is to provide compassionate care, some students feel wholly unprepared.Aims:The aim of this qualitative study was to explore student nurses’ experiences of care in death, dying and post death care, and to explore how students can be better prepared to provide such care.Methods:This is a qualitative descriptive study that is concerned with the subjective reality of participant's experiences.Findings:Six themes were developed from the analysis: first encounters with death and dying; preparedness; mentoring and support received; the caring role; striving to cope; working with families and working through COVID-19.Conclusion:Students described their experience of placements in end-of-life care as challenging, yet were also able to adopt ways to develop as compassionate practitioners.

IMPORTANCE: Systematic data on the association between anticancer therapies and thromboembolic events (TEEs) in patients with COVID-19 are lacking. OBJECTIVE: To assess the association between anticancer therapy exposure within 3 months prior to COVID-19 and TEEs following COVID-19 diagnosis in patients with cancer. DESIGN, SETTING, AND PARTICIPANTS: This registry-based retrospective cohort study included patients who were hospitalized and had active cancer and laboratory-confirmed SARS-CoV-2 infection. Data were accrued from March 2020 to December 2021 and analyzed from December 2021 to October 2022. EXPOSURE: Treatments of interest (TOIs) (endocrine therapy, vascular endothelial growth factor inhibitors/tyrosine kinase inhibitors [VEGFis/TKIs], immunomodulators [IMiDs], immune checkpoint inhibitors [ICIs], chemotherapy) vs reference (no systemic therapy) in 3 months prior to COVID-19. MAIN OUTCOMES AND MEASURES: Main outcomes were (1) venous thromboembolism (VTE) and (2) arterial thromboembolism (ATE). Secondary outcome was severity of COVID-19 (rates of intensive care unit admission, mechanical ventilation, 30-day all-cause mortality following TEEs in TOI vs reference group) at 30-day follow-up. RESULTS: Of 4988 hospitalized patients with cancer (median [IQR] age, 69 [59-78] years; 2608 [52%] male), 1869 had received 1 or more TOIs. Incidence of VTE was higher in all TOI groups: endocrine therapy, 7%; VEGFis/TKIs, 10%; IMiDs, 8%; ICIs, 12%; and chemotherapy, 10%, compared with patients not receiving systemic therapies (6%). In multivariable log-binomial regression analyses, relative risk of VTE (adjusted risk ratio [aRR], 1.33; 95% CI, 1.04-1.69) but not ATE (aRR, 0.81; 95% CI, 0.56-1.16) was significantly higher in those exposed to all TOIs pooled together vs those with no exposure. Among individual drugs, ICIs were significantly associated with VTE (aRR, 1.45; 95% CI, 1.01-2.07). Also noted were significant associations between VTE and active and progressing cancer (aRR, 1.43; 95% CI, 1.01-2.03), history of VTE (aRR, 3.10; 95% CI, 2.38-4.04), and high-risk site of cancer (aRR, 1.42; 95% CI, 1.14-1.75). Black patients had a higher risk of TEEs (aRR, 1.24; 95% CI, 1.03-1.50) than White patients. Patients with TEEs had high intensive care unit admission (46%) and mechanical ventilation (31%) rates. Relative risk of death in patients with TEEs was higher in those exposed to TOIs vs not (aRR, 1.12; 95% CI, 0.91-1.38) and was significantly associated with poor performance status (aRR, 1.77; 95% CI, 1.30-2.40) and active/progressing cancer (aRR, 1.55; 95% CI, 1.13-2.13). CONCLUSIONS AND RELEVANCE: In this cohort study, relative risk of developing VTE was high among patients receiving TOIs and varied by the type of therapy, underlying risk factors, and demographics, such as race and ethnicity. These findings highlight the need for close monitoring and perhaps personalized thromboprophylaxis to prevent morbidity and mortality associated with COVID-19–related thromboembolism in patients with cancer.

In general music classes, students participate in a variety of musical experiences, including ensembles. These may include classroom experiences playing instruments or singing as a group, or in more long-term performance-based experiences such as a musical or program. It is important that students with disabilities participate meaningfully in these experiences alongside their same-aged peers. To ensure students with disabilities are successful, teachers need to be purposeful in their classroom instruction during ensemble experiences as well as in their preparation for performances.

This study examines attempted suicide in older people between 1870 and 1908 in (NSW), Australia. Statistical Registers of NSW indicate persons aged 60+ had disproportionately high rates of apprehension (10.9%) and conviction (13.0%) for attempted suicide. Newspaper reports of 110 suicide attempts in older people indicate that alcohol misuse, poor health, depression, being tired of living, financial problems, relationship difficulties, loss events and insanity were the main issues. Most were treated compassionately with medical care and support, albeit sometimes in a gaol setting. Medical casebooks of persons aged 60+ years with suicide attempts (n = 49) or suicidal ideation (n = 43) admitted to hospitals for the insane indicated that over 75% were psychotic and 50% had melancholia.

Ultrasonic Joining (U-Joining) produces through-the-thickness reinforced (TTR) hybrid joints between thermoplastics and surface-structured metals. The joining parameters were previously optimized to join additively manufactured (AM) 316L stainless steel (316L SS) and 20% short-carbon-fiber-reinforced poly-ether-ether-ketone (PEEK-20CF) to maximize the joints' performance under quasi-static lap shear testing. However, further investigations on the joint's fracture mechanisms and cyclic loading performance are still lacking. Therefore, this study describes the stress distributions, assesses the fracture mechanisms and evaluates the fatigue life of AM 316L SS/PEEK-20CF hybrid joints. A finite element model was developed to clarify the joints' mechanical behavior, and their fatigue performance was assessed under cyclic tensile condition. The fatigue tests were performed at different percentages of the reached ultimate lap shear force (ULSF) and analyzed via two-parameter Weibull distribution and load-life curves for different reliability levels. The results showed that a fatigue life of 1 × 106cycles could be reached when a load of 1.52 kN, or 42% of the ULSF, is applied, demonstrating the joints' high mechanical performance and potential for engineering applications. Joints reaching the one million cycles threshold were stopped at this mark and tested under quasi-static lap shear to assess their residual force. The results significantly decreased from 3.6 ± 0.3 kN to 2.4 ± 0.5 kN for ULSF and residual force, respectively. Fractography analyses identified polymer delamination, partial TTR pull-out, and interfacial/net-tension failure as the main fracture mechanisms. Polymer detachment in fatigue specimens indicated the influence of secondary bending at low load levels, explaining the reduced residual force.

IMPORTANCE: Investigating how the risk of serious illness after SARS-CoV-2 infection in children and adolescents has changed as new variants have emerged is essential to inform public health interventions and clinical guidance. OBJECTIVE: To examine risk factors associated with hospitalization for COVID-19 or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) among children and adolescents during the first 2 years of the COVID-19 pandemic and change in risk factors over time. DESIGN, SETTING, AND PARTICIPANTS: This population-level analysis of hospitalizations after SARS-CoV-2 infection in England among children and adolescents aged 0 to 17 years was conducted from February 1, 2020, to January 31, 2022. National data on hospital activity were linked with data on SARS-CoV-2 testing, SARS-CoV-2 vaccination, pediatric intensive care unit (PICU) admissions, and mortality. Children and adolescents hospitalized with COVID-19 or PIMS-TS during this time were included. Maternal, elective, and injury-related hospitalizations were excluded. EXPOSURES: Previous medical comorbidities, sociodemographic factors, and timing of hospitalization when different SARS-CoV-2 variants (ie, wild type, Alpha, Delta, and Omicron) were dominant in England. MAIN OUTCOMES: PICU admission and death within 28 days of hospitalization with COVID-19 or PIMS-TS. RESULTS: A total of 10 540 hospitalizations due to COVID-19 and 997 due to PIMS-TS were identified within 1 125 010 emergency hospitalizations for other causes. The number of hospitalizations due to COVID-19 and PIMS-TS per new SARS-CoV-2 infections in England declined during the second year of the COVID-19 pandemic. Among 10 540 hospitalized children and adolescents, 448 (4.3%) required PICU admission due to COVID-19, declining from 162 of 1635 (9.9%) with wild type, 98 of 1616 (6.1%) with Alpha, and 129 of 3789 (3.4%) with Delta to 59 of 3500 (1.7%) with Omicron. Forty-eight children and adolescents died within 28 days of hospitalization due to COVID-19, and no children died of PIMS-TS (PIMS-S data were limited to November 2020 onward). Risk of severe COVID-19 in children and adolescents was associated with medical comorbidities and neurodisability regardless of SARS-CoV-2 variant. Results were similar when children and adolescents with prior SARS-CoV-2 exposure or vaccination were excluded. CONCLUSIONS: In this study of data across the first 2 years of the COVID-19 pandemic, risk of severe disease from SARS-CoV-2 infection in children and adolescents in England remained low. Children and adolescents with multiple medical problems, particularly neurodisability, were at increased risk and should be central to public health measures as further variants emerge.

Malaria is caused by Plasmodiumspecies transmitted by Anophelesmosquitoes. Following a mosquito bite, Plasmodiumsporozoites migrate from skin to liver, where extensive replication occurs, emerging later as merozoites that can infect red blood cells and cause symptoms of disease. As liver tissue-resident memory T cells (Trm cells) have recently been shown to control liver-stage infections, we embarked on a messenger RNA (mRNA)-based vaccine strategy to induce liver Trm cells to prevent malaria. Although a standard mRNA vaccine was unable to generate liver Trm or protect against challenge with Plasmodium bergheisporozoites in mice, addition of an agonist that recruits T cell help from type I natural killer T cells under mRNA-vaccination conditions resulted in significant generation of liver Trm cells and effective protection. Moreover, whereas previous exposure of mice to blood-stage infection impaired traditional vaccines based on attenuated sporozoites, mRNA vaccination was unaffected, underlining the potential for such a rational mRNA-based strategy in malaria-endemic regions.