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The advancements made in Software-Defined Networking (SDN) technology seem quite promising, with potential wide application in managing and controlling the latest network infrastructures. SDN technology decouples the control plane from the data plane, enabling effective and flexible network management. However, this dynamic phenomenon brings new security challenges. With the increasing dynamism and programmable nature of networks, conventional security protocols may not sufficient to protect against advanced and sophisticated attacks. Although Intrusion Detection Systems (IDSs) have been extensively applied for identifying and preventing security threats in traditional network environments, IDS models designed specifically for traditional network requirements may not be adequate for SDN environments. These issues may stem from the static nature of conventional networks, contrasting with the dynamicity of advanced SDN networks, and the traditional IDS’s inability to adapt to the dynamic nature of SDN. To address these challenges, the current research proposes a novel Deep Hybrid IDS model to enhance network security in SDN environments and prevent attacks using Scapy. The proposed model detects signature-based attacks by integrating Gated Recurrent Units (GRU) and Long Short-Term Memory (LSTM) for real-time simulated datasets, achieving an accuracy of 97.8%, which is comparatively better than existing models.

Background Implementation of the cardiovascular disease (CVD) prevention guidelines in the UK has been repeatedly evaluated under the auspices of the British Cardiovascular Society in three Action on Secondary and Primary Prevention by Intervention to Reduce Events (ASPIRE) surveys in 1994–1995, 2008–2010 and 2017–2019. The primary care arm of ASPIRE-2-PREVENT (A-3-P) was conducted to evaluate lifestyle and medical risk factor management in people at high risk of atherosclerotic CVD in everyday clinical practice.Methods A-3-P was a cross-sectional survey in 27 general practices and health centres across 5 English National Health Service regions. Patients with no history of atherosclerotic CVD started on blood pressure and/or lipid and/or glucose lowering treatments were identified retrospectively and interviewed at least 6 months after the initiation of medication.Results 557 patients attended the interview and examination (45.8% women; mean age 61.7±10.8 years). The risk factor control was poor: 9.3% of patients were smokers, 38.1% obese (body mass index≥30 kg/m2) and 53.5% centrally obese (waist circumference≥88 cm for women, ≥102 cm for men). Only 37.8% of patients on blood pressure-lowering therapies achieved the target of

The objective of the cyclotron radiation emission spectroscopy (CRES) technology is to build precise particle energy spectra. This is achieved by identifying the start frequencies of charged particle trajectories which, when exposed to an external magnetic field, leave semi-linear profiles (called tracks) in the time–frequency plane. Due to the need for excellent instrumental energy resolution in application, highly efficient and accurate track reconstruction methods are desired. Deep learning convolutional neural networks (CNNs) - particularly suited to deal with information-sparse data and which offer precise foreground localization—may be utilized to extract track properties from measured CRES signals (called events) with relative computational ease. In this work, we develop a novel machine learning based model which operates a CNN and a support vector machine in tandem to perform this reconstruction. A primary application of our method is shown on simulated CRES signals which mimic those of the Project 8 experiment—a novel effort to extract the unknown absolute neutrino mass value from a precise measurement of tritium β ^− -decay energy spectrum. When compared to a point-clustering based technique used as a baseline, we show a relative gain of 24.1% in event reconstruction efficiency and comparable performance in accuracy of track parameter reconstruction.

Reactor relevant fusion devices will use tungsten (W) for their plasma facing components (PFCs) due to its thermomechanical properties and low tritium retention. However, W introduces high-Z impurities into the plasma, degrading its performance. Different wall conditioning methods have been developed to address this issue, including coating of W PFCs with layers of low-Z material. Wall conditioning by boron (B) powder injection using an impurity powder dropper (IPD) is being studied in WEST. Two series of experiments were conducted since the installation of the new ITER grade full W divertor. During the first series in 2023 ∼ 1 g of B powder was injected in total at a maximum rate of ∼ 58 mg/s, both of which are three times greater than respective values in the initial WEST powder injection experiments. The second series of experiments included injection of B and BN powders for comparison of their effects on plasma performance. The presence of an instantaneous conditioning effect is suggested by visible spectroscopy measurements of low-Z impurity lines and a rollover of total radiated power past an injection rate of ∼ 20 mg/s was observed. Presence of B coating layer formation is supported by the evolution of the average radiance of visible lines of B, W and oxygen (O). To understand B transport, an interpretative modeling workflow is employed, utilizing the SOLEDGE-EIRENE fluid boundary plasma code and the Dust Injection Simulator (DIS) code. Parameters like B perpendicular diffusivity and recycling coefficients are varied to match experimental results to see if the initial assumption of B sticking to the PFCs immediately after the contact with the wall is adequate for correctly modelling its distribution on the PFCs.

Summary: Multiple metabolic events occur in mitochondria. Mitochondrial protein translocation from the cytoplasm across compartments depends on the amino acid sequence within the precursor. At the mitochondria associated-ER membrane, misfolding of a mitochondrial targeted protein prior to import ablates metabolism. CYP11A1, cytochrome P450 cholesterol side chain cleavage enzyme (SCC), is imported from the cytoplasm to mitochondrial matrix catalyzing cholesterol to pregnenolone, an essential step for metabolic processes and mammalian survival. Multiple steps regulate the availability of an actively folded SCC; however, the mechanism is unknown. We identified that a dry molten globule state of SCC exists in the matrix by capturing intermediate protein folding steps dictated by its C-terminus. The intermediate dry molten globule state in the mitochondrial matrix of living cells is stable with a limited network of interaction and is inactive. The dry molten globule is activated with hydrogen ions availability, triggering cleavage of cholesterol sidechain, and initiating steroidogenesis.

Measles is a highly infectious disease leading to high morbidity and mortality impacting people’s lives and economies across the globe. The measles vaccine saves more lives than any other vaccine in the Essential Programme of Immunization and is also the most cost-effective vaccine, with an extremely high return on investment. This makes achieving measles elimination through vaccination a key child health intervention, particularly in low-income countries, where the overwhelming majority of measles deaths continue to occur. All countries and regions of the world have committed to achieving measles elimination, yet many have faced challenges securing political commitment at national and global levels and predictable, timely, and flexible support from global donors, and experienced setbacks during the COVID-19 pandemic. This has happened against a backdrop of stagnant measles vaccination coverage and declining enthusiasm for vertical programmes, culminating in a World Health Organization Strategic Advisory Group of Experts (WHO SAGE) review of the feasibility of measles eradication in 2019. Sustaining the elimination of measles long term is extremely difficult, and some countries have lost or nearly lost their measles elimination status in the face of ongoing importation of cases from neighbouring or closely connected countries in which elimination had been delayed. Thus, a widening equity gap in measles immunisation coverage creates challenges for all countries, not just those facing the greatest burden of measles morbidity and mortality. Delaying elimination of measles in some countries makes it cumulatively harder for all countries to succeed for three principal reasons: increased inequity in measles immunisation coverage makes outbreaks more likely to happen and to be larger; political will is very difficult to sustain; and immunity may wane to a point that transmission is re-established. New strategies are needed to support countries and regions in their vision for a world without measles, including ways to galvanise domestic, regional and global resources and ignite the political will that is essential to make the vision a reality.

The mission of WEST (tungsten-W Environment in Steady-state Tokamak) is to explore long pulse operation in a full tungsten (W) environment for preparing next-step fusion devices (ITER and DEMO) with a focus on testing the ITER actively cooled W divertor in tokamak conditions. Following the successful completion of phase 1 (2016-2021), phase 2 started in December 2022 with the lower divertor made entirely of actively cooled ITER-grade tungsten mono-blocks. A boronization prior the first plasma attempt allowed for a smooth startup with the new divertor. Despite the reduced operating window due to tungsten, rapid progress has been made in long pulse operation, resulting in discharges with a pulse length of 100 s and an injected energy of around 300 MJ per discharge. Plasma startup studies were carried out with equatorial boron nitride limiters to compare them with tungsten limiters, while Ion Cyclotron Resonance Heating assisted startup was attempted. High fluence operation in attached regime, which was the main thrust of the first campaigns, already showed the progressive build up of deposits and appearance of dust, impacting the plasma operation as the plasma fluence increased. In total, the cumulated injected energy during the first campaigns reached 43 GJ and the cumulated plasma time exceeded 5 h. Demonstration of controlled X-Point Radiator regime is also reported, opening a promising route for investigating plasma exhaust and plasma-wall interaction issues in more detached regime. This paper summarises the lessons learned from the manufacturing and the first operation of the ITER-grade divertor, describing the progress achieved in optimising operation in a full W environment with a focus on long pulse operation and plasma wall interaction.

The DIII-D tokamak has elucidated crucial physics and developed projectable solutions for ITER and fusion power plants in the key areas of core performance, boundary heat and particle transport, and integrated scenario operation, with closing the core-edge integration knowledge gap being the overarching mission. New experimental validation of high-fidelity, multi-channel, non-linear gyrokinetic turbulent transport models for ITER provides strong confidence it will achieve Q ⩾ 10 operation. Experiments identify options for easing H-mode access in hydrogen, and give new insight into the isotopic dependence of transport and confinement. Analysis of 2,1 islands in unoptimized low-torque IBS demonstration discharges suggests their onset time occurs randomly in the constant β phase, most often triggered by non-linear 3-wave coupling, thus identifying an NTM seeding mechanism to avoid. Pure deuterium SPI for disruption mitigation is shown to provide favorable slow cooling, but poor core assimilation, suggesting paths for improved SPI on ITER. At the boundary, measured neutral density and ionization source fluxes are strongly poloidally asymmetric, implying a 2D treatment is needed to model pedestal fuelling. Detailed measurements of pedestal and SOL quantities and impurity charge state radiation in detached divertors has validated edge fluid modelling and new self-consistent ‘pedestal-to-divertor’ integrated modeling that can be used to optimize reactors. New feedback adaptive ELM control minimizes confinement reduction, and RMP ELM suppression with sustained high core performance was obtained for the first time with the outer strike point in a W-coated, compact and unpumped small-angle slot divertor. Advances have been made in integrated operational scenarios for ITER and power plants. Wide pedestal intrinsically ELM-free QH-modes are produced with more reactor-relevant conditions, Low torque IBS with W-equivalent radiators can exhibit predator-prey oscillations in T _e and radiation which need control. High- β _P scenarios with q _min > 2, q _95 –7.9, β _N > 4, β _T –3.3% and H _98y2 > 1.5 are sustained with high density ( $\bar n$ = 7E19 m ^−3 , f _G –1) for 6 τ _E , improving confidence in steady-state tokamak reactors. Diverted NT plasmas achieve high core performance with a non-ELMing edge, offering a possible highly attractive core-edge integration solution for reactors.

Pathogenic bacterial growth at wound sites, particularly Staphylococcus aureus , poses a serious threat during trauma. Delayed treatment can lead to increased inflammation and severe tissue damage. In this study, a chitosan cross-linked polycationic peptide-conjugated graphene-silver (CGrAP) nanocomposite hydrogel film was developed as an antibacterial wound dressing to treat S. aureus infections. The CGrAP hydrogel was synthesized via a Schiff-base reaction between the ε-poly-L-lysine functionalized graphene-silver nanocomposite and chitosan, and then cast into a film. Its antibacterial action is due to electrostatic interactions and ROS generation, finally disrupting the bacterial cells. In vivo studies on Wistar rat model demonstrated superior bacterial eradication and wound healing compared to antibiotic treatment. The CGrAP hydrogel also showed excellent physicochemical properties, including porosity, water uptake and cytocompatibility with L929 fibroblast cells along with no skin irritation or acute dermal toxicity. These results suggest that, CGrAP nanocomposite hydrogel films have strong potential for antibacterial wound dressing development in chronic wound care.

Maternity protection policies are designed to preserve the health of working women and their infants, support optimal infant and young child nutrition through breastfeeding and prevent workplace discrimination against women. The aim of this study was to identify how advocates may be able to effectively advance maternal leave and workplace lactation policies, two key maternity protection policies, and does so through an exploration of advocacy efforts in Indonesia, Nigeria, the Philippines and Vietnam. A desk review of programme and policy documents and 20 key informant interviews with diverse stakeholders explored advocacy efforts in each of the four countries. Thematic analyses of documents and interviews identified key considerations, challenges and success factors within each country context. These lessons can inform maternity protection policy reform efforts more broadly. Study findings show that effective, context-specific advocacy rests on strong partnerships with traditional and nontraditional stakeholders informed by opinion leader research and strengthened through various avenues of consensus-building. Contextual considerations are essential for identifying attainable policy asks and developing an advocacy strategy, with attention to a country's governance structure and availability of funding for social protections. Lastly, advocacy efforts may be most successful by presenting expanded paid maternity leave and breastfeeding-friendly workplaces as parts of a set of social protections with synergistic benefits. These lessons are intended to help inform how policy advocates can better design and implement advocacy approaches for maternity protection and entitlement policies., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Importance: Receipt of fluid and vasopressors, common treatments in septic shock, may affect cardiac function., Objectives: We sought to determine whether a liberal or restrictive fluid resuscitation strategy was associated with changes in cardiac function., Design: We prospectively studied a subset of patients enrolled in the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial, performing echocardiography at baseline and at 24 hours after randomization. Among patients who had an echocardiogram performed at 24 hours, we measured left ventricular global longitudinal strain (LV GLS) and right ventricular free-wall longitudinal strain (RVFWLS). We performed linear regressions with dependent variables of LV GLS, change in LV GLS (ΔLV GLS), and RVFWLS using treatment assignment as an independent variable. We adjusted for ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity, mean arterial pressure, and history of congestive heart failure and myocardial infarction., Setting: Emergency department and ICUs., Patients: Adults with sepsis enrolled in the CLOVERS trial., Main Outcomes and Measures: We enrolled 180 patients. Our analytic cohort comprised 131 patients with an echocardiogram performed at 24 hours. We observed no differences between treatment arms with respect to demographic, clinical, or echocardiographic data at baseline. We observed no association between restrictive fluid assignment and LV GLS (coefficient, 1.22; p = 0.23), ΔLV GLS (-1.97; p = 0.27), or RVFWLS (2.33; p = 0.19)., Conclusions and Relevance: In a subset of patients enrolled in CLOVERS, we observed no association between receipt of fluid and vasopressors and short-term changes in cardiac function. Decreased enrollment may limit inferences., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Background: Most studies on mental health among individuals with COPD utilize screening questionnaires, which detect psychiatric symptoms, but cannot be used to diagnose depression/anxiety disorders. We utilized the Mini International Neuropsychiatric Interview (MINI) to identify depression/anxiety disorders meeting DSM-V diagnostic criteria and described associated disease burden in people with COPD., Methods: This is a cross-sectional, secondary analysis of a multi-center study designed to evaluate anxiety questionnaires in COPD patients. Research coordinators administered both the MINI and screening questionnaires to determine participants who met diagnostic criteria for depression/anxiety disorders and capture symptom burden, respectively. Bivariate analyses were conducted to assess differences in COPD and patient-reported outcomes between those with and without depression/anxiety disorders., Results: Of 220 participants, 18 (8%) met MINI criteria for depression and 17 (8%) for anxiety. Depression was associated with more breathlessness (Modified Medical Research Council Dyspnea Scale 4 vs 3, p = 0.045), higher COPD disease burden (COPD Assessment Test (CAT) 27 vs. 17, p<0.001), worse sleep quality (Pittsburgh Sleep Quality Index 11 vs. 7, p = 0.001) and health-related quality of life (Euro Quality of Life 0.31 vs. 0.59, p <0.001. Anxiety was associated with lower CAT scores, and worse health-related quality of life and function. Most with depression/anxiety disorders were not using anti-depressants/anxiolytics, or receiving mental health counseling., Conclusion: Depression and anxiety disorders meeting diagnostic criteria are relatively common comorbidities that substantially impair quality of life and are undertreated, highlighting a need to prioritize mental health as an integral part of comprehensive COPD care., (JCOPDF © 2024.)

We describe a simple, cost-effective, green method for producing capped silver nanoparticles (Ag NPs) using a handheld portable mesh nebulizer. The precursor solution containing a 1:1 mixture of silver nitrate (AgNO 3 ) and ligand (glycerol or sodium alginate) was sprayed using the nebulizer. The Ag NPs were generated in the water microdroplets within a few milliseconds under ambient conditions without any external reducing agent or action of a radiation source. The synthesized nanoparticles were characterized by using high-resolution transmission electron microscopy (HR-TEM), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction analysis (XRD), which validated the formation of Ag NPs. The synthesized glycerate-capped silver nanoparticles (Ag-gly NPs) were used as a catalyst to show the oxidative coupling of aniline to form azobenzene products with a yield of up to 61%. Experiments conducted using Ag NPs produced in the droplets demonstrated more than 99% antibacterial activity when contacting Escherichia Coli. Our in-situ synthesis-cum-fabrication technique using a portable sprayer represents a viable alternative to the existing fiber or hydrogel-based antimicrobial wound healing., Competing Interests: The authors declare no competing interests., (© The Author(s) 2024.)

Cells coordinate their activity and regulate biological processes in response to chemical signals. Mimicking natural processes, control over the formation of artificial supramolecular materials is of high interest for their application in biology and medicine. Supramolecular material that can form in response to chemical signals is important for the development of autonomously responsive materials. Herein, a supramolecular hydrogel system is reported enabling in situ generation of hydrogelators in response to a specific chemical signal. Using self-immolative chemistry, spatial control over the formation of supramolecular hydrogel material and structured free-standing hydrogel objects via providing H 2 O 2 locally is demonstrated. In addition, a hybrid system is developed enabling in situ generation of the H 2 O 2 by the action of an enzyme and glucose, providing an extra handle for the development of an intelligent soft material. This generic design should enable the use of various (chemical)stimuli that can be obtained via coupling different stimuli and various chemical and/or biological markers and appears a versatile approach for the design of smart artificial soft materials that can find application in theranostic purposes., (© 2024 Wiley‐VCH GmbH.)

Carvacrol is a potent antimicrobial and anti-inflammatory agent, while curcumin possesses antioxidant, anti-inflammatory, and anticancer properties. These phytochemicals have poor solubility, bioavailability, and stability in their free form. Nanoencapsulation can reduce these limitations with enhanced translational capability. Integrating nanocarriers with 3D-printed calcium phosphate (CaP) scaffolds presents a novel strategy for bone regeneration. Carvacrol and curcumin-loaded nanoparticles (CC-NP) synthesized with melt emulsification produced negatively charged, monodispersed particles with a hydrodynamic diameter of ≈127 nm. Their release from the scaffold shows a biphasic release under physiological and acidic conditions. At pH 5.0, the CC-NP exhibits a 53% release of curcumin and nearly 100% release of carvacrol, compared to 19% and 36% from their respective drug solutions. At pH 7.4, ≈40% of curcumin and 76% of carvacrol releases, highlighting their pH-sensitive release mechanism. In vitro studies demonstrate a 1.4-fold increase in osteoblast cell viability with CC-NP treatment. CC-NP exhibit cytotoxic effects against osteosarcoma cells, reducing cell viability by ≈2.9-fold. The antibacterial efficacy of CC-NP evaluated against Staphylococcus aureus (SA) and Pseudomonas aeruginosa (PA) exhibiting 98% antibacterial efficacy. This approach enhances therapeutic outcomes and minimizes the potential side effects associated with conventional treatments, paving the way for innovative applications in regenerative medicine., (© 2024 The Author(s). Small published by Wiley‐VCH GmbH.)

In recent times, Electroencephalography (EEG)-based motor imagery (MI) decoding has garnered significant attention due to its extensive applicability in healthcare, including areas such as assistive robotics and rehabilitation engineering. Nevertheless, the decoding of EEG signals presents considerable challenges owing to their inherent complexity, non-stationary characteristics, and low signal-to-noise ratio. Notably, deep learning-based classifiers have emerged as a prominent focus for addressing the EEG signal decoding process. This study introduces a novel deep learning classifier named the Attention Induced Dual Convolutional-Capsule Network (AIDC-CN) with the specific aim of accurately categorizing various motor imagination class labels. To enhance the classifier's performance, a dual feature extraction approach leveraging spectrogram and brain connectivity networks has been employed, diversifying the feature set in the classification task. The main highlights of the proposed AIDC-CN classifier includes the introduction of a dual convolution layer to handle the brain connectivity and spectrogram features, addition of a novel self-attention module (SAM) to accentuate the relevant parts of the convolved spectrogram features, introduction of a new cross-attention module (CAM) to refine the outputs obtained from the dual convolution layers and incorporation of a Gaussian Error Linear Unit (GELU) based dynamic routing algorithm to strengthen the coupling among the primary and secondary capsule layers. Performance analysis undertaken on four public data sets depict the superior performance of the proposed model with respect to the state-of-the-art techniques. The code for this model is available at https://github.com/RiteshSurChowdhury/AIDC-CN., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Acute oxalate nephropathy is a rare but important cause of severe acute kidney injury. We report here two cases presenting as unexplained AKI which were confirmed histologically to be due to acute oxalate nephropathy. Dietary oxalate or its precursor vitamin C was the cause of oxalate exposure in both of these cases. While one patient recovered, another continued to need dialysis and succumbed to underlying metastatic cancer. This cause should be suspected in all patients presenting with unexplained AKI, and detailed history about dietary intake of oxalate or vitamin C should be inquired., Competing Interests: Declarations. Conflict of interest: None (attached the form). Ethical approval: All procedures performed in this report were in accordance with the ethical standards of the institute and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: Attached., (© 2024. The Author(s), under exclusive licence to Japanese Society of Nephrology.)

Peptides have gained tremendous popularity as biological therapeutic agents in recent years due to their favourable specificity, diversity of targets, well-established screening methods, ease of production, and lower cost. However, their poor physiological and storage stability, pharmacokinetics, and fast clearance have limited their clinical translation. Novel nanocarrier-based strategies have shown promise in overcoming these issues. In this direction, porous silicon (pSi) and mesoporous silica nanoparticles (MSNs) have been widely explored as potential carriers for the delivery of peptide therapeutics. These materials possess several advantages, including large surface areas, tunable pore sizes, and adjustable pore architectures, which make them attractive carriers for peptide delivery systems. In this review, we cover pSi and MSNs as drug carriers focusing on their use in peptide delivery. The review provides a brief overview of their fabrication, surface modification, and interesting properties that make them ideal peptide drug carriers. The review provides a systematic account of various studies that have utilised these unique porous carriers for peptide delivery describing significant in vitro and in vivo results. We have also provided a critical comparison of the two carriers in terms of their physicochemical properties and short-term and long-term biocompatibility. Lastly, we have concluded the review with our opinion of this field and identified key areas for future research for clinical translation of pSi and MSN-based peptide therapeutic formulations., (© 2024. The Author(s).)

Background: The treatment of chronic limb-threatening ischemia (CLTI) involves a broad spectrum of therapies including many new and emerging techniques. To standardize the results of studies examining this pathology and to allow critical analysis and comparison between studies, the Society for Vascular Surgery (SVS) recommended reporting standard guidelines for the endovascular management of CLTI in 2016. Research studies that do not adhere to complete reporting standards are often more ambiguous in impact and external validity, leading to bias and misinformation that has potentially damaging effects on clinical decision-making. We thus sought to examine adherence to and factors associated with noncompliance with these recommended guidelines., Methods: A literature database search was conducted to include all clinical trials, randomized controlled trials, and retrospective comparative studies written in English examining the endovascular treatment of peripheral artery disease (PAD)/CLTI from January 2020 to August 2022. Systematic reviews, case reports, and meta-analysis were excluded. The manuscripts were reviewed for adherence with the SVS guidelines (overall and by guideline subcategories based on demographics, treatment methods, and outcomes), and factors associated with this adherence were determined. These data were used to calculate descriptive and comparative statistics., Results: Fifty-four manuscripts were identified from this time frame. On average, articles reviewed reported on 42.0% of the SVS reporting standards (range, 25.0-65.2%, Fig 1) with 74.1% of articles (n = 40) not adhering to at least 50.0% of the standards. Manuscripts most completely followed guidelines regarding "patient factors" and were least likely to demonstrate adherence to the description of CLTI and study complications. Within the guideline subcategories, complete adherence to guidelines was not demonstrated in any manuscript in stent trials, disease outcome measures, technical outcome measures, patient factors and critical limb ischemia description, and complete adherence rates within the other subcategories was low (range, 5.6-18.6%). Studies conducted within the United States and those with industry sponsorship were more likely to adhere to >50% of the reporting standards (P < 0.05). Journal impact factor, year of publication, and number of authors had no correlation to the percent adherence to guidelines in specific categories or adherence overall., Conclusions: Adherence to reporting standard guidelines for endovascular treatment of lower extremity PAD specifically outlined by the SVS is suboptimal regardless of the quality of the journal the research is published in. Increasing adherence to reporting standards to provide a framework for comparison of studies across techniques used should be prioritized by authors, journal editors, and vascular societies., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Increasing bone diseases and anomalies significantly challenge bone regeneration, necessitating the development of innovative implantable devices for effective healing. This study explores the potential of 3D-printed calcium phosphate (CaP) scaffolds functionalized with natural medicine to address this issue. Specifically, quercetin and vitamin D3 (QVD) encapsulated solid lipid nanoparticles (QVD-SLNs) are incorporated into the scaffold to enhance bone regeneration. The melt emulsification method is utilized to achieve high drug encapsulation efficiency (~98%) and controlled biphasic release kinetics. The process-structure-property performance of these systems allows more controlled release while maintaining healthy cell-material interactions. The functionalized scaffolds show ~1.3- and ~-1.6-fold increase in osteoblast cell proliferation and differentiation, respectively, as compared with the control. The treated scaffold demonstrates a reduction in osteoclastic activity as compared with the control. The QVD-SLN-loaded scaffolds show ~4.2-fold in vitro chemopreventive potential against osteosarcoma cells. Bacterial assessment with both Staphylococcus aureus and Pseudomonas aeruginosa shows a significant reduction in bacterial colony growth over the treated scaffold. These findings summarize that the release of QVD-SLNs through a 3D-printed CaP scaffold can treat various bone-related disorders for low or non-load-bearing applications., (© 2024 The Author(s). Journal of Biomedical Materials Research Part A published by Wiley Periodicals LLC.)

Introduction: Following new dialysis access creation there is no consensus on the optimal use of anti-thrombotic therapy. Recent studies have suggested that single antiplatelet therapy may improve hospital mortality as well as patency. The aim of this study was to assess the role of different antiplatelet and anticoagulation therapies on outcomes following dialysis access creation., Material and Methods: A retrospective study was conducted utilizing patients from the Vascular Quality Initiative who underwent AV fistula (AVF) and AV graft (AVG) creation from 2011-2023. Patients who were antiplatelet and anticoagulation naive were separated into four cohorts: no antiplatelet (No APT), single antiplatelet (SAPT), dual antiplatelet (DAPT), and aspirin with anticoagulation (ASA + AC). Univariate Kaplan-Meier (KM) and multivariable regression analyses were conducted to assess overall survival, primary patency, and secondary patency., Results: 49,980 patients with AVF creation and 12,688 patients with AVG creation were identified. AVG patients had improved 1-year primary patency with SAPT compared to No APT (48% vs 44%, p = 0.03) on KM analysis. No difference on KM analysis was observed for AVF. Regression analysis showed decreased risk of loss of primary patency for AVF (HR 0.90, CI 0.83-0.97, p = 0.009). AVG with SAPT showed decreased risk of mortality (HR 0.80, CI 0.64 - 1.00, p = 0.05) and decreased risk of loss of primary patency (HR 0.80, CI 0.67-0.94, p = 0.009). DAPT also showed decreased risk of loss of primary patency for AVG (HR 0.64, CI 0.43-0.95, p = 0.028). Survival was worse for both AVF and AVG patients on ASA + AC on KM analysis., Conclusions: Single antiplatelet therapy following access creation improves primary patency for both AVF and AVG, as well as overall survival for those with AVG. DAPT may further improve primary patency in those with AVG. The use of anticoagulation shows no clear benefit and may be harmful, however is more likely to reflect higher risk patients with other co-morbidities. These results suggest that following an AVF one should consider discharging patients on SAPT, and following an AVG one should consider SAPT or DAPT., (Published by Elsevier Inc.)

Background: Kidney transplant recipients (KTRs) show poor antibody response to the SARS-CoV-2 vaccine. There is limited data on immune response to non-mRNA vaccines in KTRs. We studied the antibody response to the SARS-CoV-2 non-mRNA vaccine in a cohort of kidney transplant recipients., Methods: We included KTRs following up in the tertiary care transplant outpatient clinic from February to April 2022. SARS-CoV-2 spike protein IgG antibody titers were measured using chemiluminescence immunoassay. Data on demographic, clinical, and laboratory characteristics were collected, and patients were characterized by the history of Coronavirus disease 2019 (COVID-19) infection in the past and the number of vaccine doses received. Predictors of antibody response were obtained using multivariate regression analysis., Results: S1/S2 IgG anti-SARS-CoV-2 antibodies were detected in 197 (87.94%) of 224 KTRs with a median [IQR] titers of 307.5 AU/ml [91 AU/ml - 400 AU/ml]. Neutralizing range antibody titers were found in 170/224 (75.9%) KTRs. Diabetes at the time of vaccination was associated with poorer antibody response (aOR 0.31, 95% confidence interval [CI] - 0.10, 0.90; p = 0.032) and vaccination with Covishield™ (ChAdOx1 nCoV- 19 Recombinant CoronaVirus Vaccine) showed higher antibody response as compared to Covaxin™ (BBV152) (aOR 5.04, 95% CI - 1.56, 16.22; p = 0.007). Graft dysfunction at baseline was associated with poorer antibody response., Conclusions: KTRs showed good antibody response after SARS-CoV-2 vaccination with non-mRNA vaccines. Diabetes and graft dysfunction were associated with poor seroconversion rates., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Research has been driven to demonstrate organic light-emitting diodes (OLEDs) with high efficiency, and in the quest for new materials, thermally activated delayed fluorescence (TADF) emitters have been employed. Preparation of donor-acceptor (D-A) π-conjugates is a useful guideline for developing TADF emitters. TADF emitters have shown excellent progress and high maximum external quantum efficiency (EQE max ) for OLEDs in the recent past; however, they suffer with substantial roll-off resulting in a decrease in their efficiency. In order to have efficient OLED emitters with less efficiency roll-off, we designed a xanthone-amine derivative with twisted electron-rich dibenzoazepine having limited rotation at the donor-acceptor bond. Xan-Azepine shows solvent polarity-dependent fluorescence in the range of 441- 597 nm having a lifetime below 10 ns. At 77 K in Me-THF, a triplet at 557 nm was observed having a decay lifetime of 0.75 s and an afterglow for about 6 s. In powder, it shows dual emission, i.e., fluorescence (490 and 6 ns) and phosphorescence (530 nm and 192 μs) at ambient conditions. The energy difference between the singlet and triplet energy levels of Xan-Azepine is found to be 0.18 eV in the powder sample. Its blend in 4,4'-bis(N-carbazolyl)-1,1'-biphenyl (CBP) showed delayed fluorescence with a lifetime of 118 μs at 300 K, while it reduced to 84 μs at 150 K. These observations suggest the TADF nature of Xan-Azepine in its CBP blend. OLED devices of Xan-Azepine showing a turn-on voltage of 2.8 V and a EQE max of 12% were successfully fabricated. In the doped films of Xan-Azepine (5 wt %) with CBP, a maximum luminescence of 5980 Cd/m 2 at a current density of 70 mA/cm 2 was obtained, resulting in devices with low-efficiency roll-off (2.75%).

Water microbubbles containing Fe 2+ ions have been found to efficiently transform nitrogen (N 2 ) to nitrate (NO 3 ) by initiating Fenton's reaction at the gas-water interface. Herein, we elucidate the mechanism of the formation of nitrate (NO - ) by initiating Fenton's reaction at the gas-water interface. Herein, we elucidate the mechanism of the formation of nitrate (NO 3 - ) from nitrogen (N 2 ) at the microbubble interface. Several experimental studies were conducted to identify the intermediates formed during the conversion. Our investigation shows the formation of H 2 N 2 O 2 , NO, NO 2 , and NO 2 - intermediates before yielding NO 3 - as the final product. Density functional theory (DFT) calculations provide additional support to our observation by providing insights into the energy profiles of the reaction intermediates. We believe that this work not only provides valuable insight into the abiotic nitrogen fixation in microbubbles but also helps in suggesting the modification of parameters to create a more reactive interface that leads to the enhanced production of nitric acid (HNO 3 )., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Many animal cells that crawl on extracellular substrates exhibit durotaxis, i.e., directed migration toward stiffer substrate regions. This has implications in several biological processes including tissue development and tumor progression. Here, we introduce a phenomenological model for single-cell durotaxis that incorporates both elastic deformation-mediated cell-substrate interactions and the stochasticity of cell migration. Our model is motivated by a key observation in an early demonstration of durotaxis: a single, contractile cell at a sharp interface between a softer and a stiffer region of an elastic substrate reorients and migrates toward the stiffer region. We model migrating cells as self-propelling, persistently motile agents that exert contractile traction forces on their elastic substrate. The resulting substrate deformations induce elastic interactions with mechanical boundaries, captured by an elastic potential. The dynamics is determined by two crucial parameters: the strength of the cellular traction-induced boundary elastic interaction (A), and the persistence of cell motility (Pe). Elastic forces and torques resulting from the potential orient cells perpendicular (parallel) to the boundary and accumulate (deplete) them at the clamped (free) boundary. Thus, a clamped boundary induces an attractive potential that drives durotaxis, while a free boundary induces a repulsive potential that prevents antidurotaxis. By quantifying the steady-state position and orientation probability densities, we show how the extent of accumulation (depletion) depends on the strength of the elastic potential and motility. We compare and contrast crawling cells with biological microswimmers and other synthetic active particles, where accumulation at confining boundaries is well known. We define metrics quantifying boundary accumulation and durotaxis, and present a phase diagram that identifies three possible regimes: durotaxis, and adurotaxis with and without motility-induced accumulation at the boundary. Overall, our model predicts how durotaxis depends on cell contractility and motility, successfully explains some previous observations, and provides testable predictions to guide future experiments., Competing Interests: Declaration of interests The authors do not declare any conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

A defining signature of classical systems is "in principle measurability" without disturbance: a feature manifestly violated by quantum systems. We describe a multi-interferometer experimental setup that can, in principle, reveal the nonclassicality of a spatial superposition-sourced gravitational field if an irreducible disturbance is caused by a measurement of gravity. While one interferometer sources the field, the others are used to measure the gravitational field created by the superposition. This requires neither any specific form of nonclassical gravity, nor the generation of entanglement between any relevant degrees of freedom at any stage, thus distinguishing it from the experiments proposed so far. This test, when added to the recent entanglement-witness based proposals, enlarges the domain of quantum postulates being tested for gravity. Moreover, the proposed test yields a signature of quantum measurement induced disturbance for any finite rate of decoherence, and is device independent.

Introduction: The Ion Endoluminal Platform (ION) (IEPI Intuitive, Sunnyvale, CA), a minimally invasive robotic-assisted bronchoscopy platform, was recently US Food and Drug Administration approved for the performance of fine needle aspirations (FNAs) and biopsies of peripheral lung lesions. Rapid on-site intraoperative diagnosis (IOD) of FNAs and/or frozen section of biopsies help surgeons confirm adequate sampling of the targeted lesion and allow definitive treatment in selected cases., Materials and Methods: We retrospectively reviewed our experience with all FNAs of lung lesions sampled by interventional pulmonologists and thoracic surgeons using Ion from September 2020 to December 2022. IOD rendered during adequacy assessment were compared with final cytology diagnoses (Cyto-FD) and the ultimate final diagnoses (U-FD). The U-FD was based on the sum of all clinical, imaging, cytologic, and histologic diagnoses of the lung lesion which the clinical team used to treat the patient., Results: The IOD and Cyto-FD were concordant in 62% of the 423 lesions that underwent intraoperative evaluation, yielding a sensitivity of 67% and a specificity of 99% for malignancy. The Cyto-FD and U-FD were concordant in 51% of the lesions with a sensitivity and specificity for malignancy of 66% and 100%, respectively., Conclusions: IODs rendered during Ion were highly accurate but only moderately sensitive for a diagnosis of malignancy., (Copyright © 2024 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

3D printing has revolutionized bone tissue engineering (BTE) by enabling the fabrication of patient- or defect-specific scaffolds to enhance bone regeneration. The superior biocompatibility, customizable bioactivity, and biodegradability have enabled calcium phosphate (CaP) to gain significance as a bone graft material. 3D-printed (3DP) CaP scaffolds allow precise drug delivery due to their porous structure, adaptable structure-property relationship, dynamic chemistry, and controlled dissolution. The effectiveness of conventional scaffold-based drug delivery is hampered by initial burst release and drug loss. This review summarizes different multifunctional drug delivery approaches explored in controlling drug release, including polymer coatings, formulation integration, microporous scaffold design, chemical crosslinking, and direct extrusion printing for BTE applications. The review also outlines perspectives and future challenges in drug delivery research, paving the way for next-generation bone repair methodologies., Competing Interests: Declaration of interests No interests are declared., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Competing Interests: Declaration of competing interest RCW, JGW, RM, BL, NA, VL, NM, KR, CH, LGQ and DS have no disclosures. SB reports participating on the advisory board of Sanofi.

Objective: Controversy exists regarding the value and limitations of different sites of service for peripheral artery disease treatment. We aimed to examine practice patterns associated with peripheral vascular interventions (PVIs) performed in the office-based laboratory (OBL) vs outpatient hospital site of service using a nationally representative database., Methods: Using 100% Medicare fee-for-service claims data, we identified all patients undergoing PVI for claudication or chronic limb-threatening ischemia (CLTI) between January 2017 and December 2022. We evaluated the associations of patient and procedure characteristics with site of service using multivariable hierarchical logistic regression. We used multinomial regression models to estimate the relative risk ratios (RRRs) of site of service and intervention type (angioplasty, stent, or atherectomy) and intervention anatomic level (iliac, femoropopliteal, or tibial) after adjusting for baseline patient characteristics and clustering by physician., Results: Of 848,526 PVI, 485,942 (57.3%) were performed in an OBL. OBL use increased significantly over time from 48.3% in 2017 to 65.5% in 2022 (P < .001). Patients treated in OBLs were more likely to be Black (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.11-1.18) or other non-White race (aOR, 1.13; 95% CI, 1.08-1.18), have fewer comorbidities, and undergo treatment for claudication vs CLTI (aOR, 1.30; 95% CI, 1.26-1.33) compared with patients treated in outpatient hospital settings. Physicians with majority practice (>50% procedures) in an OBL were more likely to practice in urban settings (aOR, 21.58; 95% CI, 9.31-50.02), specialize in radiology (aOR, 18.15; 95% CI, 8.92- 36.92), and have high-volume PVI practices (aOR, 2.15; 95% CI, 2.10-2.29). The median time from diagnosis to treatment was shorter in OBLs, particularly for patients with CLTI (29 vs 39 days; P < .001). The OBL setting was the strongest predictor of patients receiving an atherectomy alone (adjusted RRR [aRRR] 6.67; 95% CI, 6.59-6.76) or atherectomy + stent (aRRR, 10.84; 95% CI, 10.64-11.05), and these findings were consistent in subgroup analyses stratified by PVI indication. The OBL setting was also associated with higher risk of tibial interventions for both claudication (aRRR, 3.18; 95% CI, 3.11-3.25) and CLTI (aRRR, 1.89; 95% CI, 1.86-1.92). The average reimbursement (including professional and facility fees) was slightly higher for OBLs compared with the hospital ($8742/case vs $8459/case; P < .001). However, in a simulated cohort resetting the OBL's intervention type distribution to that of the hospital, OBLs were associated with a hypothetical cost savings of $221,219,803 overall and $2602 per case., Conclusions: The OBL site of service was associated with greater access to care for non-White patients and a shorter time from diagnosis to treatment, but more frequently performed high-cost interventions compared with the outpatient hospital setting. The benefit to patients from improved access to peripheral artery disease care in OBL settings must be balanced with the potential limitations of receiving differential care., Competing Interests: Disclosures J.J.S. reports an educational grant paid to Boston University by W. L. Gore & Associates and BD. M.L.W. reports relationships with W. L. Gore & Associates and Cook Medical that are unrelated to this work. C.W.H. reports relationships with Cook Medical, Inc. (speaker's bureau), W. L. Gore & Associates (speaker's bureau), and Silk Road Medical (speaker's bureau) that are not related to this work., (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Among survivors of critical illness, prescription of potentially inappropriate medications (PIM) at hospital discharge is thought to be an important, modifiable patient safety concern. To date, there are little empirical data evaluating this issue., Research Question: The objective of this study was to determine the frequency of PIM prescribed to survivors of acute respiratory failure (ARF) at hospital discharge and explore their association with readmissions or death within 90 days of hospital discharge., Study Design and Methods: Prospective multicenter cohort study of ARF survivors admitted to ICUs and discharged home. Prospective of new PIMs with a high-adverse-effect profile ("high impact") at discharge was the primary exposure. Potential inappropriateness was determined by a structured consensus process using Screening Tool of Older Persons' Prescriptions-Screening Tool to Alert to Right Treatment, Beers' criteria, and clinical context of prescriptions by a multidisciplinary team. Covariate balancing propensity score was used for the primary analysis., Results: Of the 195 Addressing Post Intensive Care Syndrome-01 (APICS-01) patients, 169 (87%) had ≥1 new medications prescribed at discharge, with 154 (91.1%) prescribed with one or more high-impact (HI) medications. Patients were prescribed a median of 5 [3-7] medications, of which 3 [1-4] were HI. Twenty percent of HI medications were potentially inappropriate. Medications with significant central nervous system side-effects were most prescribed potentially inappropriately. Forty-six (30%) patients experienced readmission or death within 90 days of hospital discharge. After adjusting for prespecified covariates, the association between prescription of potentially inappropriate HI medications and the composite primary outcome did not meet the prespecified threshold for statistical significance (risk ratio: 0.54; 0.26-1.13; p = 0.095) or with the constituent endpoints: readmission (risk ratio: 0.57, 0.27-1.11) or death (0.7, 0.05-9.32)., Conclusion: At hospital discharge, most ARF survivors are prescribed medications with a high-adverse-effect profile and approximately one-fifth are potentially inappropriate. Although prescription of such medications was not associated with 90-day readmissions and mortality, these results highlight an area for additional investigation., (Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Cicatricial alopecias are chronic, progressive scarring hair-loss conditions. Molecular dysregulation is not fully understood, hindering treatment development. Th1/IFNγ signaling and Janus kinase dysregulation has shown involvement, providing rationale for this phase 2a trial with Tyrosine kinase 2/Janus kinase 1 inhibitor brepocitinib., Methods: Randomized, placebo-controlled phase 2a trial spanning 52 weeks. Adults (≥18 years of age) with lichen planopilaris, frontal fibrosing alopecia, or central centrifugal cicatricial alopecia diagnosis were randomized 3:1 to brepocitinib 45 mg daily or placebo for 24 weeks, after which all patients received brepocitinib for another 24 weeks, with a safety follow up 4 weeks later. Lesional scalp biopsies were collected at baseline, week 24, and week 48. Coprimary endpoints were changes in lesional expression of C-C motif chemokine ligand (CCL5), changes in lesional expression of fibrosis-related markers, and safety at week 24., Results: Patients receiving brepocitinib showed significant downregulation in CCL5 expression at week 24 (P = .004). Enrichment analysis of a subset of fibrosis markers showed trending upregulation in placebo patients (P < .1). Brepocitinib was well tolerated and improved clinical severity scores., Limitations: Single-dose regimen, small placebo group., Conclusion: Brepocitinib significantly reduces CCL5 expression and was well tolerated at week 24, meeting coprimary endpoints. Brepocitinib reduces inflammatory biomarker expression and improves clinical severity, while maintaining favorable safety profile., Competing Interests: Conflicts of interest Dr Meariman is a consultant for Abbvie. Dr Ungar is an employee of Mount Sinai and has received research funds (grants paid to the institution) from: Incyte, Rapt Therapeutics, and Pfizer. He is also a consultant for Arcutis Biotherapeutics, Bristol Myers Squib, Castle Biosciences, Fresenius Kabi, Galderma, Janssen, Lilly, Pfizer, Primus Pharmaceuticals, Sanofi, and UCB. Dr Guttman-Yassky is an employee of Mount Sinai and has received research funds (grants paid to the institution) from: Abbvie, Celgene, Eli Lilly, Janssen, Medimmune/Astra Zeneca, Novartis, Pfizer, Regeneron, Vitae, Glenmark, Galderma, Asana, Innovaderm, Dermira, UCB. They are also a consultant for Sanofi Aventis, Regeneron, Stiefel/GlaxoSmithKline, MedImmune, Celgene, Anacor, AnaptysBio, Dermira, Galderma, Glenmark, Novartis, Pfizer, Vitae, Leo Pharma, Abbvie, Eli Lilly, Kyowa, Mitsubishi Tanabe, Asana Biosciences, and Promius. Drs Oemar, Mahling, and Peeva are Pfizer employees and own stock and stock option. Authors David, Shokrian, Hawkins, Sikand, Singer, Estrada, Bose, and Pulsinelli, and Drs Duca, Dubin, Andrews, and Da Rosa have no conflicts of interest to declare., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Biofilm-associated wound infection is principally perceived as the bacterial defense mechanism that hinders antibiotic penetration, causes toxin impairment, and suppresses the immunological responses of the host immune system. Several antibiofilm agents have been developed, but the least of these agents can simultaneously cornerstone on the biofilm-associated immunosuppression and bacterial toxin-induced cellular dysfunction. Inspired by the fusogenic property of nanodroplets and immunomodulatory functions of metal nanoparticles, biofilm targeted anti-virulent immunomodulatory cationic nanoparticle shelled nanodroplets (C-AgND) is fabricated to completely disintegrate and eradicate the Staphylococcus aureus (S. aureus) biofilm. The specific binding of C-AgND neutralizes the negatively charged EPS layer, causing their destabilization followed by penetration of the nanoformulation into the biofilm matrix, killing the persister cells. Consequently, C-AgND eliminates the virulence property of the S. aureus biofilm through α-hemolysin neutralization. C-AgND promotes a strong immunomodulatory effect by polarizing macrophages into their M1 phenotype to induce phagocytosis of the disintegrated biofilm-released residual cells, rejuvenating the host's innate immune responses for the complete eradication of the biofilm. Moreover, the ex vivo skin wound infection model illustrates an excellent biofilm eradication efficacy of C-AgND in comparison to the commercial ones, rendering them to be a promising replacement of existing antibiofilm agents in clinical application., (© 2024 Wiley‐VCH GmbH.)

Electronic Health Records (EHRs) are increasingly used to develop machine learning models in predictive medicine. There has been limited research on utilizing machine learning methods to predict childhood obesity and related disparities in classifier performance among vulnerable patient subpopulations. In this work, classification models are developed to recognize pediatric obesity using temporal condition patterns obtained from patient EHR data in a U.S. study population. We trained four machine learning algorithms (Logistic Regression, Random Forest, Gradient Boosted Trees, and Neural Networks) to classify cases and controls as obesity positive or negative, and optimized hyperparameter settings through a bootstrapping methodology. To assess the classifiers for bias, we studied model performance by population subgroups then used permutation analysis to identify the most predictive features for each model and the demographic characteristics of patients with these features. Mean AUC-ROC values were consistent across classifiers, ranging from 0.72-0.80. Some evidence of bias was identified, although this was through the models performing better for minority subgroups (African Americans and patients enrolled in Medicaid). Permutation analysis revealed that patients from vulnerable population subgroups were over-represented among patients with the most predictive diagnostic patterns. We hypothesize that our models performed better on under-represented groups because the features more strongly associated with obesity were more commonly observed among minority patients. These findings highlight the complex ways that bias may arise in machine learning models and can be incorporated into future research to develop a thorough analytical approach to identify and mitigate bias that may arise from features and within EHR datasets when developing more equitable models., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Campbell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We report a simple, direct, and green conversion of air/N 2 to nitric acid by bubbling the gas through an aqueous solution containing 50 μM Fe 2+ ions. Air stone, along with ultrasonication, was employed to generate gas microbubbles. H 2 O 2 produced at the water-gas interface undergoes Fenton's reaction with Fe 2+ ions to produce OH • that efficiently activates N 2 , yielding nitric acid as the final product. Nitrate (NO 3 - ) formation occurs without the use of any external electric potential or radiation. The concentration of NO 3 - increased linearly with time over a period of 132 h. The average NO 3 - production rate is found to be 12.9 ± 0.05 μM h -1 . We envision that this nitrogen fixation strategy that produces nitric acid in an eco-friendly way might open the possibility for the energy-efficient and green production of nitric acid.

Alive & Thrive (A&T) provides strategic technical assistance (TA) to develop effective policies; improve maternal, infant, and young child nutrition (MIYCN) programme design and implementation and enhance system capacity to sustain quality MIYCN service delivery at scale. A qualitative assessment was conducted using document review and stakeholder interviews (n = 79) to describe a selection of A&T's TA in six countries and systematically assess the contextual and TA process-related factors that influenced the results achieved and document the lessons learned about MIYCN TA design and implementation. To facilitate the selection of different types of TA, we classified TA into two levels of stakeholder engagement and intensity. Under the Technical Advisor TA category, we assessed A&T's support to strengthen national policy formulation, monitoring, and implementation of the International Code of Marketing of Breast-milk Substitutes. For Capacity Development TA, we assessed A&T support to scale-up maternal nutrition services and to increase strategic use of data. Factors important for TA provision included identifying and engaging with the right people, using evidence to support advocacy and decision-making, using multiple ways to strengthen capacity, developing packages of tools to support programme scale-up, and reinforcing feedback mechanisms to improve service provision and data quality. Challenges included shifts in the political context, poorly functioning health systems, and limited resources to replicate or sustain the progress made. Continued investment in evidence-based and practical TA that strengthens the institutionalization of nutrition across all stakeholders-including government, medical associations, civil society and development partners-is essential. Future TA must support governments to strengthen system capacity for nutrition, including financial and human resource gaps that hamper full scale-up., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Metal-organic frameworks (MOFs) have shown promise in both capturing CO 2 under flue gas conditions and converting it into valuable chemicals. However, the development of a single MOF capable of capturing and selectively converting CO 2 has remained elusive due to a lack of a harmonious combination of selectivity, water stability, and reactivity. For example, Cu(I)-based MOFs are particularly effective for CO 2 conversion, but they do not typically exhibit selective CO 2 adsorption and often suffer from instability in the presence of air and moisture. Developing a Cu(I) MOF that is stable under flue gas conditions while also capturing CO 2 from this mixture would likely afford a material capable of selectively capturing and converting CO 2 in an integrated pathway, which would represent a significant advancement in this field. In this study, we introduce NU-2100 , an ultramicroporous Cu(I) MOF, which exhibits both selectivity for CO 2 adsorption and great stability even in the presence of moisture and air. Comprehensive evaluations involving exposure to air, oxygen, water, and varying temperatures reveal that NU-2100 demonstrates superior stability compared to other known Cu(I) MOFs. Utilizing adsorption isotherms and thermogravimetric analysis coupled with gas chromatography-mass spectrometry (TGA-GCMS), we establish the high selectivity of NU-2100 for CO 2 over common flue gas components, including water, nitrogen, and oxygen. Additionally, under mild reaction conditions (50 °C and H 2 :CO 2 = 3:1), NU-2100 exhibits CO 2 capture and catalytic conversion to formic acid with 100% selectivity. This study marks an important step toward the design of next-generation MOFs capable of integrated carbon capture and utilization (iCCU) under industrial conditions.

Introduction: Differential access to new technologies may contribute to racial disparities in surgical outcomes but has not been well-studied in the treatment of carotid artery stenosis. We examined race-based differences in adoption and outcomes of transcarotid artery revascularization (TCAR) among high-risk non-Hispanic (NH) NH Black and NH white adults undergoing carotid revascularization., Methods: We conducted a retrospective analysis of TCAR, transfemoral carotid artery stenting (TF-CAS), and carotid endarterectomy (CEA) procedures performed for carotid artery stenosis from 1/2015 to 7/2023 in the Vascular Quality Initiative. NH Black and NH white adults were included if they met Centers for Medicare & Medicaid Services high-risk criteria. Hospitals and physicians were categorized as TCAR-capable if they had previously performed at least one TCAR prior to the time of a given procedure. We fit logistic and linear regressions, adjusted a priori for common demographic, clinical, and disease characteristics, to estimate associations of race with receipt of TCAR (versus CEA or TF-CAS), and to explore associations between race, hospital and physician characteristics, and perioperative composite stroke/death/myocardial infarction., Results: Of 159,471 high-risk patients undergoing revascularization for carotid artery stenosis (mean age 72 years, 38.5% female, 5.3% NH Black), 28,722 (18.0%) received TCAR, including 16.9% of NH Black adults and 18.1% of NH white adults (P<0.001). After controlling for patient and disease characteristics, NH Black patients were less likely than NH white patients to receive TCAR (aOR 0.92, 95% CI 0.87 to 0.99). The use of TCAR did not vary by race among patients treated at TCAR-capable hospitals (aOR 0.98, 95% CI 0.91 to 1.05) or by TCAR-capable physicians (aOR 1.01, 95% CI 0.93 to 1.10); however, NH Black race was associated with lower odds of receiving treatment in these settings (TCAR-capable hospital: aOR 0.93 [0.88 to 0.98]; TCAR-capable physician: aOR 0.92 [0.87 to 0.98]). NH Black race was associated with higher odds of stroke/death/MI in the full cohort (aOR 1.18, 95% CI 1.03 to 1.36), but not in the subgroup of patients who received TCAR (aOR 0.87, 95% CI 0.56 to 1.34)., Conclusions: TCAR attenuated racial disparities in perioperative morbidity and mortality associated with carotid revascularization, but NH Black adults were less likely than NH white adults to receive TCAR. Relatively worse access for NH Black adults to technologically-advanced treatment settings may partially explain the broader persistence of race-based differences in carotid revascularization treatment patterns and outcomes., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: Smoking is an important modifiable risk factor in all vascular diseases and verbal advice from providers has been shown to increase rates of tobacco cessation. We sought to identify factors that will improve tobacco cessation and recall of receiving verbal cessation advice in vascular surgery patients at a single institution., Methods: The study is a retrospective cohort study. Patients seen in outpatient vascular surgery clinic who triggered a tobacco Best Practice Advisory (BPA) during their office visits over a 10-month period were contacted post-clinic and administered surveys detailing smoking status, cessation advice recall, and validated scales for nicotine dependence and willingness to quit smoking. This BPA is a "hard stop" that requires providers to document actions taken. Charts were reviewed for tobacco cessation documentation. Nine-digit zip-codes identified the area deprivation index, a measure of socioeconomic status. Univariate analysis was used to identify factors associated with cessation and advice recall., Results: One hundred out of 318 (31.4%) patients responded to the survey. Epic Slicer Dicer found 97 BPA responses. To dismiss the BPA, 89 providers (91.8%) selected "advised tobacco cessation" and "Unable to Advise" otherwise. Of the 318 patients, 115 (36.1%) had cessation intervention documented in their provider notes and 151 (47.5%) received written tobacco cessation advice. Of survey respondents, 70 recalled receiving verbal advice, 27 recalled receiving written advice, 28 reported receiving offers of medication/therapy for cessation. 55 patients reported having tobacco cessation plans, and among those 17 reported having quit tobacco. Recall of receiving written advice (P < .001) and recall of receiving medication/therapy (P = .008) were associated with recall of receiving verbal cessation advice., Conclusions: Providing patients with tobacco cessation medication/therapy and written tobacco cessation education during office visits is associated with increased patients' recall of tobacco cessation advice. Vascular surgeons should continue to provide directed tobacco cessation advice., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for severe blunt thoracic aortic injuries (BTAI). Successful outcomes rely on accurate endograft sizing, but initial imaging may underestimate aortic diameters. This study examines the impact of intravascular ultrasound (IVUS) on endograft sizing and clinical outcomes in BTAI patients., Methods: A prospectively collected multi-institutional dataset from the Aortic Trauma Foundation was analyzed. Patients with BTAI undergoing TEVAR with IVUS were compared to patients who underwent TEVAR alone. Demographics and operative variables were compared, focusing on IVUS effects on endograft sizing by examining maximal proximal and distal aortic diameter on initial CT imaging compared to the graft diameters used during TEVAR., Results: 293 patients underwent TEVAR for BTAI with IVUS utilized in 124 cases (42.3%). The average graft size in the IVUS and non-IVUS groups were similar proximally (26.91 ± 4.3 mm IVUS vs 27.77 ± 4.7 mm non-IVUS, P = 0.116) and distally (25.96 ± 4.7 mm IVUS vs 26.51 ± 4.7 mm non-IVUS). IVUS did not impact the difference between graft size and initial CT measurements proximally (4.32 ± 4.8 mm IVUS vs 4.23 ± 3.9 mm non-IVUS, P = 0.859) or distally (4.17 ± 5.9 mm IVUS vs 4.50 ± 4.3 mm non-IVUS, P = 0.606). Although delayed hemorrhagic and ischemic stroke occurred less frequently in IVUS patients (0.8% IVUS vs 7.1% non- IVUS, P = 0.024), in-hospital mortality was similar between groups (5.6% IVUS vs 7.7% non-IVUS, P = 0.581)., Conclusions: IVUS is not associated with significant changes in endograft sizing compared to sizing based on CT scan alone in BTAI patients. IVUS was not associated with differences in mortality but was associated with a decrease in delayed hemorrhagic and ischemic stroke. Routine IVUS in BTAI patients may not be necessary for accurate sizing, but there may be a relationship between IVUS and stroke., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Patients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored., Objective: To explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in-patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge., Design: Single center retrospective cohort study., Setting and Participants: Patients admitted to a tertiary-level medical center with either a primary diagnosis of RT-PCR positive for COVID-19 or high index of clinical suspicion thereof., Intervention: None., Main Outcome and Measures: Exposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28-day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge., Results: 1319 patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42-4.12; p = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID-19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28-day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm., (© 2024 Society of Hospital Medicine.)

Purpose: Sarcoma encompasses a diverse group of cancers that are typically resistant to current therapies, including immune checkpoint blockade (ICB), and underlying mechanisms are poorly understood. The contexture of sarcomas limits generation of high-quality data using cutting-edge molecular profiling methods, such as single-cell RNA-sequencing, thus hampering progress in understanding these understudied cancers., Experimental Design: Here, we demonstrate feasibility of producing multimodal single-cell genomics and whole-genome sequencing data from frozen tissues, profiling 75,716 cell transcriptomes of five undifferentiated pleomorphic sarcoma and three intimal sarcoma samples, including paired specimens from two patients treated with ICB., Results: We find that genomic diversity decreases in patients with response to ICB, and, in unbiased analyses, identify cancer cell programs associated with therapy resistance. Although interactions of tumor-infiltrating T lymphocytes within the tumor ecosystem increase in ICB responders, clonal expansion of CD8+ T cells alone was insufficient to predict drug responses., Conclusions: This study provides a framework for studying rare tumors and identifies salient and treatment-associated cancer cell intrinsic and tumor microenvironmental features in sarcomas., (©2024 The Authors; Published by the American Association for Cancer Research.)

Background: Heart failure is a leading cause of death in the USA, contributing to high expenditures near the end of life. Evidence remains lacking on whether billed advance care planning changes patterns of end-of-life healthcare utilization among patients with heart failure. Large-scale claims evaluation assessing billed advance care planning and end-of-life hospitalizations among patients with heart failure can fill evidence gaps to inform health policy and clinical practice., Objective: Assess the association between billed advance care planning delivered and Medicare beneficiaries with heart failure upon the type and quantity of healthcare utilization in the last 30 days of life., Design: This retrospective cross-sectional cohort study used Medicare fee-for-service claims from 2016 to 2020., Participants: A total of 48,466 deceased patients diagnosed with heart failure on Medicare., Main Measures: Billed advance care planning services between the last 12 months and last 30 days of life will serve as the exposure. The outcomes are end-of-life healthcare utilization and total expenditure in inpatient, outpatient, hospice, skilled nursing facility, and home healthcare services., Key Results: In the final cohort of 48,466 patients (median [IQR] age, 83 [76-89] years; 24,838 [51.2%] women; median [IQR] Charlson Comorbidity Index score, 4 [2-5]), 4406 patients had an advance care planning encounter. Total end-of-life expenditure among patients with billed advance care planning encounters was 19% lower (95% CI, 0.77-0.84) compared to patients without. Patients with billed advance care planning encounters had 2.65 times higher odds (95% CI, 2.47-2.83) of end-of-life outpatient utilization with a 33% higher expected total outpatient expenditure (95% CI, 1.24-1.42) compared with patients without a billed advance care planning encounter., Conclusions: Billed advance care planning delivery to individuals with heart failure occurs infrequently. Prioritizing billed advance care planning delivery to these individuals may reduce total end-of-life expenditures and end-of-life inpatient expenditures through promoting use of outpatient end-of-life services, including home healthcare and hospice., (© 2024. The Author(s).)

Oligonucleotides have been identified as powerful therapeutics for treating genetic disorders and diseases related to epigenetic factors such as metabolic and immunological dysfunctions. However, they face certain obstacles in terms of limited delivery to tissues and poor cellular uptake due to their large size and often highly charged nature. Peptide-oligonucleotide conjugation is an extensively utilized approach for addressing the challenges associated with oligonucleotide-based therapeutics by improving their delivery, cellular uptake and bioavailability, consequently enhancing their overall therapeutic efficiency. In this review, we present an overview of the conjugation of oligonucleotides to peptides, covering the different strategies associated with the synthesis of peptide-oligonucleotide conjugates (POC), the commonly used peptides employed to generate POCs, with the aim to develop oligonucleotides with favourable pharmacokinetic (PK) or pharmacodynamic (PD) properties for therapeutic applications. The advantages and drawbacks of the synthetic methods and applications of POCs are also described.

Background: Mastectomy and breast reconstruction with latissimus dorsi myocutaneous flap (LDF) is a major surgery that covers eight or more dermatomes causing severe pain in the postoperative period., Objectives: We evaluated the analgesic effect of a hybrid technique of ultrasound-guided combined thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in a single needle pass in ten consecutive patients scheduled for mastectomy with LDF reconstruction as a part of a multimodal analgesia regimen., Design: Prospective observational study., Setting: A tertiary-level cancer hospital in Eastern India. The study was conducted between 01/09/2023 and 20/12/2023., Patients: 10 consecutive consenting female patients of age between 18 and 75 years suffering from breast cancer, scheduled for a mastectomy with LDF reconstruction were recruited in this study, excluding patients with body mass index more than 40, coagulopathy or thrombocytopenia, skin conditions such as dermatitis, infection and so on, and known allergy to local anaesthetics (LAs)., Interventions: The recruited patients received an ultrasound-guided combined thoracic paravertebral and erector spinae (COMPARES) block at the third thoracic (T3) level in a single needle pass, with 10 mL in the TPVB and 30 mL in the ESPB compartment, respectively, in a cephalad to caudad approach before induction of general anaesthesia., Main Outcome Measures: The primary endpoint was pain score at 9:00 am on postoperative day one. Other outcome measures were pain scores at postoperative hours 0 (immediately after awakening from general anaesthesia), 4, 8 and 12, postoperative nausea vomiting, requirement of rescue analgesics and pain score on shoulder movements on postoperative day one., Results: Median (range) resting pain scores at 0, 4, 8 and 24 hours were 1.5 (0-5), 2.5 (0-4), 2.5 (2-5) and 3 (2-4), and dynamic pain score on shoulder mobilization on postoperative day one morning was 3 (2-6). Only one patient required rescue analgesia., Conclusions: We found the technique inexpensive and potentially useful, but difficult in obese and short-statured patients due to increased depth and narrowing of the intertransverse space. This technique should be further evaluated in a randomised controlled trial., Trial Registration: This trial was registered with the Clinical Trials Registry of India with the registration number CTRI/2023/08/057119., Competing Interests: The authors declare no conflicts of interest., (© the authors; licensee ecancermedicalscience.)