Search

Background: Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity. The aim of this study was to evaluate the effect of anthracycline treatment on the outcome of cancer patients with sepsis. Methods: Data from cancer patients admitted to intensive care units (ICUs) for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994–2015). Comparison between patients who received anthracycline and those who did not was performed using a propensity score, including confounding variables (age and underlying diseases). A competing risk adjusted for severity of illness (Sequential Organ Failure Assessment [SOFA] score) was used to analyze the duration of vasopressor requirement. Results: Among 2046 patients, 1070 (52.3%) patients who received anthracycline were compared with 976 (47.7%) who did not. The underlying disease was mostly acute hematological malignancy (49.2%). Sepsis, mostly pneumonia (47.7%), had developed 2 days (interquartile range [IQR]:1–4 days) prior to ICU admission. Most patients (n=1156/1980,58.4%) required vasopressors for 3 days (IQR: 2–6 days). Factors associated with the need for vasopressors were aplasia (hazard ratio [HR]=1.72, 95% confidence interval [CI]: 1.21 to 2.47, P=0.002) and day 1 respiratory SOFA score (HR=7.07, 95% CI: 2.75 to 22.1, P

The synthesis of silver nanoparticles with controlled physicochemical properties is essential for governing their intended functionalities and safety profiles. However, synthesis process involves multiple parameters that could influence the resulting properties. This challenge could be addressed with the development of predictive models that forecast endpoints based on key synthesis parameters. In this study, we manually extracted synthesis-related data from the literature and leveraged various machine learning algorithms. Data extraction included parameters such as reactant concentrations, experimental conditions, as well as physicochemical properties. The antibacterial efficiencies and toxicological profiles of the synthesized nanoparticles were also extracted. In a second step, based on data completeness, we employed regression algorithms to establish relationships between synthesis parameters and desired endpoints and to build predictive models. The models for core size and antibacterial efficiency were trained and validated using a cross-validation approach. Finally, the features’ impact was evaluated via Shapley values to provide insights into the contribution of features to the predictions. Factors such as synthesis duration, scale of synthesis and the choice of capping agents emerged as the most significant predictors. This study demonstrated the potential of machine learning to aid in the rational design of synthesis process and paves the way for the safe-by-design principles development by providing insights into the optimization of the synthesis process to achieve the desired properties. Finally, this study provides a valuable dataset compiled from literature sources with significant time and effort from multiple researchers. Access to such datasets notably aids computational advances in the field of nanotechnology.

Absorbed dose heterogeneity in kidney tissues is an important issue in radiopharmaceutical therapy. The effect of absorbed dose heterogeneity in nephrotoxicity is, however, not fully understood yet, which hampers the implementation of treatment optimization by obscuring the interpretation of clinical response data and the selection of optimal treatment options. Although some dosimetry methods have been developed for kidney dosimetry to the level of microscopic renal substructures, the clinical assessment of the microscopic distribution of radiopharmaceuticals in kidney tissues currently remains a challenge. This restricts the anatomical resolution of clinical dosimetry, which hinders a thorough clinical investigation of the impact of absorbed dose heterogeneity. The potential of absorbed dose–response modelling to support individual treatment optimization in radiopharmaceutical therapy is recognized and gaining attraction. However, biophysical modelling is currently underexplored for the kidney, where particular modelling challenges arise from the convolution of a complex functional organization of renal tissues with the function-mediated dose distribution of radiopharmaceuticals. This article reviews and discusses the heterogeneity of absorbed dose distribution in kidney tissues and the absorbed dose–response modelling of nephrotoxicity in radiopharmaceutical therapy. The review focuses mainly on the peptide receptor radionuclide therapy with beta-particle emitting somatostatin analogues, for which the scientific literature reflects over two decades of clinical experience. Additionally, detailed research perspectives are proposed to address various identified challenges to progress in this field.

Background and objective: More than 10% of patients with negative clinical metastatic status (cN0M0) on conventional imaging for prostate cancer (PCa) harbor lymph node involvement (pN+) at final pathology following radical prostatectomy (RP) and lymphadenectomy. Our aim was to assess outcomes of initial observation for cN0M0 pN+ PCa and identify prognostic factors that may help in clinical decision-making. Methods: We performed a retrospective multicenter study of patients with cN0M0 PCa on conventional imaging (computed tomography and/or magnetic resonance imaging, and a bone scan) who were found to have pN+ disease at RP between 2000 and 2021. Biochemical recurrence (BCR) and systemic progression/recurrence were the primary outcomes. Kaplan-Meier curves and Cox proportional hazards model were used for survival and multivariate analysis. Key findings and limitations: A total of 469 men were included in this retrospective multicenter trial. Median prostate-specific antigen (PSA) was 10.1 ng/ml (interquartile range [IQR] 6.6–18.0). Among these patients, 56% had grade group ≥4, 53.7% had stage ≥pT3b, 42.6% had positive margins, and 19.6% had PSA persistence. The median number of positive nodes and of nodes removed were 1 (IQR 1–3) and 20 (14–28), respectively. At median follow-up of 41 mo, 48.5% experienced BCR. The 5-yr BCR-free survival rate was 31.7% (95% confidence interval [CI] 26.33–37.1%). Salvage treatments were needed in 211 patients and included radiotherapy (RT; n = 53), RT + androgen deprivation therapy (ADT; n = 88), ADT alone (n = 68), and salvage lymphadenectomy (n = 2). The 5-yr estimated survival rates were 66.3% (95% CI 60.4–72.1) for metastasis-free survival, 97.7% (95% CI 95.5–99.8%) for cancer-specific survival, and 95.3% (95% CI 92.4–98.1%) for overall survival. On multivariable analysis, PSA persistence was an independent predictor of BCR (odds ratio [OR] 51.8, 95% CI 12.2–219.2), exit from observation (OR 8.5, 95% CI 4.4–16.5), and systemic progression (OR 3.0, 95% CI 1.771–4.971). Conclusions: Initial observation in the management of pN+ cN0M0 PCa is feasible and has excellent survival rates in the intermediate term. Patients with worse disease features, especially PSA persistence, have a higher likelihood of recurrence and progression and may be candidates for more aggressive upfront management. Patient summary: We investigated the value of initial observation for men with prostate cancer with negative scan findings for metastasis who were then found to have positive lymph nodes after surgery to remove the prostate. Our results show that initial observation is a good option for patients with less aggressive prostate cancer features.

Purpose: A systematic review to identify treatment approaches for the management of pain following peripheral nerve injury. Methods: A published literature search was performed for the concepts of peripheral nerve injury and pain management with related synonyms. The strategies were created using a combination of controlled vocabulary terms and keywords and were executed in Embase.com, Ovid-Medline All, and Scopus from database inception. Database searches were completed on August 22, 2023. Results: The initial search resulted in a total of 1,793 citations. In total, 724 duplicates were removed, leaving 1,069 unique citations remaining for analysis. This review excluded all papers that were not specific to pain following peripheral nerve injury. Case and cohort studies (n < 5) were also excluded. Thirty-two articles on pain management strategies after peripheral nerve injury remained, with years of publication ranging from 1981 to 2023. An additional four articles were identified by manual search. Of the 36 articles reviewed, 15 articles reported on the approach to the treatment of pain after a peripheral nerve injury, and the other 22 articles consisted of cohort and case series studies. Conclusions: There is a lack of literature describing efficacy of various treatment strategies for pain following peripheral nerve injuries. Few studies provide clear, stepwise clinical guidance for practicing physicians and other health care providers on the treatment of these complicated patients.

Continuous, non-invasive, and objective methods to detect flock-level responses to stressors, including intestinal health deviations, are currently lacking in poultry. This proof of principle study investigated the potential of manure odor profiling in monitoring stress responses in Lohmann Brown Classic, Lohmann LSL Classic and Lohmann LSL Lite layer pullets. Stressors were represented by a Salmonella vaccination given to the pullets at wk 3 of age (Dataset 1 and Dataset 2) and wk 16 of age (Dataset 4) and a viral/bacterial vaccine cocktail given at wk 12 of age (Dataset 3). Fresh manure was sampled daily, from 2 days before vaccination to 4 days after vaccination, with 4 pooled manure samples per day per dataset. Manure volatiles were concentrated into stainless steel sorbent tubes and analyzed by a thermal desorption system coupled with gas chromatography-mass spectrometry. Dataset, breed and sample location did not affect the manure volatile profiles before vaccination. Age did affect the manure volatile profiles, with beta-camphor, (Z)-6-Tridecene and serinol peak intensities elevated in young pullets and carbonyl sulfide and trimethylamine elevated in older pullets. Salmonella vaccination at wk 3 of age led to the most consistent changes in volatile peak intensities. (Z)-6-Tridecene was decreased in Dataset 1, Dataset 3, and Dataset 4 after either the Salmonella vaccination or the viral/bacterial vaccine cocktail, despite differences in hen age and house. The injected viral/bacterial vaccine cocktail created a more clear time-dependent shift in the manure volatile profile than the orally-provided Salmonella vaccination in older pullets at resp. wk 12 and 16 of age. No overlapping trends in upregulated or downregulated volatiles were found between all datasets. To conclude, volatile profiles of rearing hen manure are affected by vaccinations as a proxy for stressors, and the magnitude and direction of the response depends on the age of the pullets at vaccination, the vaccination method, and the pathogenic properties of the vaccine. The reduced peak intensities of volatiles after vaccination in 3 out of 4 flocks suggests the potential of manure odor profiling in monitoring stress responses in layer pullets.

Background: Areas of conduction disorders play an important role in both initiation and perpetuation of AF and can be recognized by specific changes in unipolar potential morphology. For example, EGM fractionation may be caused by asynchronous activation of adjacent cardiomyocytes because of structural barriers such as fibrotic strands. However, it is unknown whether there are sex differences in unipolar potential morphology. Therefore, atrial potential morphologies during sinus rhythm (SR) were compared between male and female patients. Methods: Based on propensity score matching, 62 male and female patients in whom high-resolution mapping of the right atrium (RA), left atrium (LA), and pulmonary vein area (PVA) including Bachmann’s bundle (BB) was performed during coronary bypass grafting surgery and/or valvular heart surgery. Unipolar potentials were classified as single potentials (SPs), short double potentials (SDPs), long double potentials (LDP), fractionated potentials (FPs) and fraction duration (FD). The proportion of conduction block lines was also determined. Results: Female patients had a higher proportion of SDPs, LDPs and FPs at the RA, and SDPs at BB. At the PVA, there were less SPs and more SDPs and FPs. In females, FDs were longer at the RA and PVA, and potential voltages of only SPs were lower at the RA (all P

Summary: Background: Children from racial and ethnic minority groups are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they have increased risk for post-acute sequelae of SARS-CoV-2 (PASC). Our objectives were to assess whether the risk of respiratory and neurologic PASC differs by race/ethnicity and social drivers of health. Methods: We conducted a retrospective cohort study of individuals

Accurate evapotranspiration (ET) estimation is crucial for optimizing irrigation and managing water resources at the field scale. This study investigates the potential of unmanned aerial vehicles (UAVs) equipped with the MicaSense Altum sensor for high-resolution ET mapping using the Hybrid Single Source Energy Balance (HSEB) model. We focused on a 4.5 ha sprinkle-irrigated potato field at the American University of Beirut Agricultural Research and Education Center (AREC) in Lebanon’s Bekaa Valley. Eleven UAV flights were conducted throughout the growing season, synchronized with Landsat 8 and 9, and MODIS LST overpasses. HSEB ET from the Altum sensor was compared against EC data from a flux tower setup, and a comparative analysis was performed with HSEB ET from Landsat 8, Landsat 9, and Sentinel-2 (with MODIS LST). HSEB ET from the UAV exhibited very close agreement (3 % lower) with EC data, with a low RMSE of 0.60 mm/day. Notably, UAV-derived land surface temperature (LST) was on average 3 % higher than infrared radiometer LST. In contrast, comparisons of UAV LST with Landsat and S2MOD LST data revealed significant overestimations of LST (43 % and 24 %, respectively). Consequently, HSEB ET from Landsat and S2MOD were lower than EC ET by 17 % and 6 %, respectively. The strong agreement between UAV-HSEB and EC data underscores the potential of UAV thermal data for accurate irrigation management in heterogeneous fields using the HSEB model. While limitations exist regarding coverage area and cost, the detailed information obtained from UAVs can be highly valuable for optimizing irrigation practices and improving water use efficiency at sub-field scales.

Summary: The severity of COVID 19 symptoms has a direct correlation with lymphopenia, affecting natural killer (NK) cells. SARS-CoV-2 specific “memory” NK cells obtained from convalescent donors can be used as cell immunotherapy. In 2022 a phase I, dose-escalation, single center clinical trial was conducted to evaluate the safety and feasibility of the infusion of CD3−/CD56+ NK cells against moderate/severe cases of COVID-19 (NCT04578210). Six participants with pneumonia and/or lymphopenia were infused. Four patients received a single-dose infusion of NK cells of 1×106/kg, and the following two patients a dose of 2×106/kg of NK cells. All participants’ clinical status and inflammation markers were monitored. No serious adverse events were reported after infusion. Exploratory outcomes included the donor chimerism, NK-cell immunophenotype evolution, and immune lymphocyte reconstitution. This study provides preliminary evidence supporting the idea that treatment of COVID-19 patients with moderate/severe symptoms using NK from COVID-19 convalescent donors is feasible and safe.

Understanding effects of extreme heat across diverse settings is critical as social determinants play an important role in modifying heat-related risks. We apply a multi-scale analysis to understand spatial variation in the effects of heat across Mexico and explore factors that are explaining heterogeneity. Daily all-cause mortality was collected from the Mexican Secretary of Health and municipality-specific extreme heat events were estimated using population-weighted temperatures from 1998 to 2019 using Daymet and WorldPop datasets. We analyzed the association between single-day extreme heat events defined at the 99th percentile of the same-day maximum temperature and mortality, and seven heat threshold metrics based on relative and absolute scales were considered as sensitivity analyses. A time-stratified case-crossover was applied to evaluate heat impacts across 32 states in Mexico. A within-community matched design with Bayesian Hierarchical model explored effects across 2456 municipalities. A random-effects meta-regression was applied to understand which municipality-level socio-demographic characteristics such as education, age and housing predicted observed spatial heterogeneity. Extreme heat increased the odds of mortality overall, and this was consistent across extreme heat thresholds. At the state level, extreme heat events showed highest impact on mortality in Tabasco [OR: 1.23, 95% CI: 1.17, 1.30]. The municipality-level spatial analysis showed substantial differences across regions with highest effects observed along the eastern, southwestern and Sonora coasts. Municipalities with older populations, higher marginalization, lower education, and poorer housing conditions were more vulnerable to heat effects. Understanding the differential risks of extreme heat events at varying scales is important to prioritize at-risk populations in action plans and policies to reduce their burden.

Although various plant protein (PP) ingredients are available on the market, their application in foods is not trivial, and food companies are struggling to identify PP ingredients fitting the intended use. To fill this gap, abundant literature has appeared but data are hardly comparable due to the absence of a recognized classification of PP ingredients accounting not only for protein purity but also for the process history, and of standardised protocols for technological functionality assessment. In this review, a comprehensive analysis of comparable literature data was thus carried out to elucidate the effect of composition and processing variables on PP technological functionalities. The review presents four sections describing: (i) the approach followed for the construction of a database of PP ingredient functionalities; (ii) the composition and processing factors relevant to PP ingredients; (iii) PP ingredient functional properties and methods used for their determination; (iv) the effect of composition and processing factors on PP ingredient functionalities. This analysis showed legume proteins to present the highest solubility and interfacial properties while pseudocereal ones the highest water-holding capacity. Although pure ingredients show higher functionalities, non-protein components could contribute to interfacial properties. Alkaline extraction, isoelectric precipitation and freeze-drying is the process mostly used in academic research to obtain PP ingredients. However, other extraction, purification, and drying methods can be properly combined, resulting in specific PP ingredient functionalities. Overall, this review highlights that, besides protein purity and source, knowledge of the processing history is required to select PP ingredients with desired functionalities.

Background: The mental health of university students is a global concern, with high rates of depression and anxiety that need to be addressed. Aim: We aimed to compare the mental health of Portuguese, Swedish and German university students in the health and social sciences following the Covid-19 pandemic and to analyze the factors associated with depressive and anxious symptoms in each country. Methods: A cross-sectional study with a sample of students from Portugal, Germany and Sweden was conducted. Data from online questionnaires, including a sociodemographic and clinical questionnaire, the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder (GAD-7) and the MHI-5 (Mental Health Inventory) was collected from October to December 2022. Results: The sample was composed of 1670 university students. The prevalence of mild to severe depressive symptoms was 72.7 % in Germany, 62.9 % in Sweden, and 60.3 % in Portugal and the prevalence of mild to severe anxiety symptoms was 78.6 % in Portugal, 73.7 % in Germany, and 66.9 % in Sweden. Being a female student, having a previous mental health disorder diagnosis, and poor academic performance were associated with higher severity of depression and anxiety symptoms in all three countries. Country-specific factors associated with more depressive and/or anxiety symptoms were younger age, smoking, low socioeconomic level and living away from home. Swedish students who do not consume alcohol had more anxiety symptoms and German students who do not consume alcohol had more depressive symptoms. Conclusion: The high prevalence of depressive and anxiety symptoms among students in the three countries highlights the need to address modifiable factors that contribute to this mental health burden. Our results, which are in line with international trends, underline the need for policy reforms that target the main determinants of mental health, in particular by improving socio-economic conditions. Addressing these factors could play a crucial role in improving mental health outcomes in this population.

Summary: Epithelial cells respond to infection with the intracellular bacterial pathogen Listeria monocytogenes by altering their mechanics to promote collective infected cell extrusion (CICE) and limit infection spread across cell monolayers. However, the underlying biochemical pathways remain elusive. Here, using in vitro (epithelial monolayers) and in vivo (zebrafish larvae) models of infection with L. monocytogenes or Shigella flexneri, we explored the role of extracellular-signal-regulated kinase (ERK) activity waves in coordinating the mechanical battle between infected and surrounder uninfected cells that leads to CICE. We discovered that when ERK waves are suppressed, cells fail to exhibit alterations in cell shape and kinematics associated with CICE and behave more like quiescent uninfected monolayers. In particular, uninfected cells surrounding infection foci are unable to polarize, reinforce their monolayer stresses, and promote CICE. Our findings reveal that crosstalk between ERK waves and cell mechanics is key to collective elimination of large domains of infected cells.

Summary: Social learning plays an essential role in all cultural processes, but the factors underlying its evolution remain poorly understood. To understand how socio-ecological conditions affect social learning, we compared peering behavior (i.e., close-range observation of conspecifics’ activities) in wild and zoo-housed Sumatran orangutans. Using long-term data describing over 3,000 peering events (performed by 65 individuals across settings), we found similar age trajectories of peering in both settings. Moreover, immatures universally preferred to peer at older individuals and in learning-intense contexts. However, zoo-housed immatures peered more frequently, and more at non-mother individuals than their wild conspecifics, even when social opportunities were controlled for. Therefore, although similarities across settings suggest that the tendency to attend to social information has hard-wired components, the differences indicate that it is also influenced by social opportunities and the necessity to learn. Our comparative approach thus provides evidence that socio-ecological factors and genetic predispositions underlie the dynamics and evolution of culture.

Background: Smoking is the leading cause of preventable death in the United States. We interviewed Tobacco Cessation Champions, multi-sector decision makers, across the state of Michigan to assess and identify barriers and facilitators of smoking cessation and the current smoking cessation landscape. Methods: Twenty Tobacco Cessation Champion interviews (n = 20) were completed with multi-sector decision makers to assess implementation barriers and facilitators from May 2022 to September 2023. We used rapid qualitative analysis to identify common themes across the Tobacco Cessation Champion interviews. Results: Three key themes were identified across the Tobacco Cessation Champion interviews: 1) Facilitators and Barriers of Smoking Cessation Efforts; 2) Smoking Cessation Efforts: Underfunded, Underutilized, Not Marketable or Accessible, and 3) Need for more inclusive, person-centered smoking cessation interventions. Conclusion: Across the themes identified in the present report, champions identified myriad areas for improvement in the tobacco cessation landscape, including: Appeal, accessibility, and the functionality of current systems. The community should strive to improve trust and relationships between providers and patients, as the trust established between these parties is imperative for promoting tobacco cessation. Lastly, cessation efforts should aim to address and improve attitudes and stigma toward smoking and tobacco cessation.

Background & Aims: The dynamics of HBV viral load (VL) in patients with chronic hepatitis B (CHB) on nucleos(t)ide analogue (NA) treatment and its relationship with liver disease are poorly understood. We aimed to study longitudinal VL patterns and their associations with CHB clinical outcomes. Methods: Utilising large scale, routinely collected electronic health records from six centres in England, collated by the National Institute for Health and Care Research Health Informatics Collaborative (NIHR HIC), we applied latent class mixed models to investigate VL trajectory patterns in adults receiving NA treatment. We assessed associations of VL trajectory with alanine transaminase, and with liver fibrosis/cirrhosis. Results: We retrieved data from 1,885 adults on NA treatment (median follow-up 6.2 years, IQR 3.7–9.3 years), with 21,691 VL measurements (median 10 per patient, IQR 5–17). Five VL classes were identified from the derivation cohort (n = 1,367, discrimination: 0.93, entropy: 0.90): class 1 ‘long term suppression’ (n = 827, 60.5%), class 2 ‘timely virological suppression’ (n = 254, 18.6%), class 3 ‘persistent moderate viraemia’ (n = 140, 10.2%), class 4 ‘persistent high-level viraemia’ (n = 44, 3.2%), and class 5 ‘slow virological suppression’ (n = 102, 7.5%). The model demonstrated a discrimination of 0.93 and entropy of 0.88 for the validation cohort (n = 518). Alanine transaminase decreased variably over time in VL-suppressed groups (classes 1, 2, 5; all p

Mung beans are promising for protein ingredient production, but their benefits are hindered by potential antinutritional factors and coloring compounds in the hull, resulting in darker-colored products. To address this issue, this study aims to identify a germination period that enhances dehulling efficiency while minimizing mass losses and chemical alterations. Mung bean seeds were soaked overnight and germinated in the dark for 4, 8, 12, 24, 32, and 48 h, with the effects on dehulling efficiency, enzymatic activities, and chemical composition, including antinutritional factors, examined.After 48 h of germination, a substantial increase in enzyme activities was observed: lipolytic activities increased by 644 %, amylolytic activities by 200 %, and polyphenol oxidase activity by 280 %. A decline in protein (21.02–25.77 %), starch (41.83–56.65 %), and fat (0.35–1.03 %) content was detectable after 48 h of germination. SDS-PAGE analysis revealed a reduction in globulins and structural changes with prolonged germination. Total phenolic content was particularly reduced by 20 % due to dehulling. Short-term germination within 12 to 24 h was found to be an effective strategy to facilitate dehulling of mung bean seeds while reducing antinutritional factors and preserving their chemical composition, thus improving their potential as a high-quality raw material for plant-based foods.

Objective: We assessed the global distribution and academic, administrative and research outcomes of international fellows (IFs) trained in Canadian gynecologic oncology (GO) programs. Methods: A web-based survey was sent to IFs who completed GO training in Canada. Using the Web of science database, we identified the publication list, citation record and H-index of IFs and classified them according to their region of practice: high-income countries (HIC), middle income countries (MIC), and low-income countries (LIC). Results: From 1996 to 2020, 81 IFs from 23 countries were trained in English-speaking (62,9%) and French-speaking Canadian universities (37,1%). Most IFs came from HIC (87,6%) and none from LIC. Only 12 IFs (14,8%) are now practicing in Canada. Of the 55 IFs who completed the survey (response rate: 67,9%), the majority (58,2%) reported working in an academic hospital and 29,1% were holding an executive position in a national scholar organization. IFs participated in mentoring residents (96.4 %) and medical students (83,6%) and 36,3% initiated a GO fellowship program in their home country. 67,3% of IFs were involved in international research collaboration and 52,7% participated in international clinical trials. The mean number of publications (22,36 vs 7,75, p = 0.007), citations (369,15 vs 45,12 p = 0.0006) and H-Index (6,88 vs 2,37 p = 0.0001) were significantly higher among IFs working in HIC compared to those in MIC. Most IFs (98,2%) recommended their Canadian GO fellowship program to a colleague from their home country. Conclusion: Most IFs trained in Canadian GO fellowship programs returned to their home countries and achieved important milestones in terms of academic, clinical and research accomplishments.

A retrospective cohort study was conducted in Malta to assess the prevalence of threatened miscarriage. The study focuses on cases managed at a local state hospital over a 12-month period. Currently, data on pregnancies prior to 22 weeks’ gestation are not publicly available, which hampers understanding of the frequency and impact of threatened miscarriage. This research provides the basis for a potential prospective study which analysis the epidemiology and outcomes of threatened miscarriage and advocates for early intervention and appropriate patient counselling. The study included females who visited the Accident and Emergency Department in a local state hospital in 2019 with first trimester vaginal bleeding. It excluded patients with incomplete medical records. Data from various hospital departments were collected, anonymised and analysed to track outcomes such as miscarriage, ongoing pregnancy, ectopic or molar pregnancy. The research aimed to create a comprehensive local registry of pregnancy outcomes following threatened miscarriage, reflecting the national situation. In 2019, 711 pregnant women in Malta experienced first-trimester vaginal bleeding. Of these, 241 had successful births beyond 22 weeks’ gestation, while 412 experienced miscarriages, with other outcomes including ectopic and molar pregnancies and 58 women had an unknown pregnancy outcome. A significant association was found between maternal age and risk of miscarriage, particularly higher for women aged 35–46 and those under 19. Birthweight data revealed that threatened miscarriage complications likely led to low birthweights in a significant proportion of newborns. This study analysed pregnancy outcomes which were preceded by first trimester vaginal bleeding in pregnant women in Malta. Establishing a local register of pregnancy outcomes following first trimester vaginal bleeding provides clinicians with enhanced insights into the current local context. This resource may improve patient counselling and informed policy decisions and lay the groundwork for future research in the field.

Background: The integration of work coaches (WCs) and disability employment advisors (DEAs) into General Practitioner (GP) practices in the UK aims to address the interplay between health and employment by facilitating access to employment support, especially to people with disabilities and health conditions affecting their ability to work. This study seeks to explore the perspectives and perceptions of WCs, DEAs and GPs regarding the benefits and challenges of embedding WCs and DEAs in GP practices. Methods: Data was collected between May and July 2023 through semi-structured interviews with four GPs, four WCs and four DEAs working in NHS GP practices. The interviews were audio-recorded, transcribed verbatim and thematically analysed using the Thematic Framework method. Emergent themes were pre-structured and classified as perceived benefits, barriers and challenges or drivers and strategies. Results: The integration of WCs & DEAs within GP practices was perceived by respondents as fostering a direct collaboration between professionals as well as a greater openness of patients which benefited patients, WCs/DEAs and GPs. While all respondents emphasised the various benefits, they also identified several barriers and challenges. The implementation stage was perceived as particularly challenging, especially by WCs and DEAs, whereas the lack of human, financial and logistical resources hindered the service beyond this stage. Several strategies and drivers to support the service were identified, including the importance of receiving support from all professionals involved as well as making the service visible to both healthcare professionals and patients. Conclusion: Embedding WCs and DEAs in GP practices emerges as a promising approach which can benefit patients, GPs and WCs/DEAs. Exploring patients' perspectives directly is crucial to fully assess this type of service and identify any additional challenges and benefits.

Microglia represent the main resident immune cells of the brain. The interplay between microglia and other cells in the central nervous system, such as neurons or other glial cells, influences the function and ability of microglia to respond to various stimuli. These cellular communications, when disrupted, can affect the structure and function of the brain, and the initiation and progression of neurodegenerative diseases including Alzheimer's disease and Parkinson's disease, as well as the progression of other brain diseases like glioblastoma. Due to the difficult access to patient brain tissue and the differences reported in the murine models, the available models to study the role of microglia in disease progression are limited. Pluripotent stem cell technology has facilitated the generation of highly complex models, allowing the study of control and patient-derived microglia in vitro. Moreover, the ability to generate brain organoids that can mimic the 3D tissue environment and intercellular interactions in the brain provide powerful tools to study cellular pathways under homeostatic conditions and various disease pathologies. In this review, we summarise the most recent developments in modelling degenerative diseases and glioblastoma, with a focus on brain organoids with integrated microglia. We provide an overview of the most relevant research on intercellular interactions of microglia to evaluate their potential to study brain pathologies.

Diabetes mellitus (DM) is one of the most prevalent cardiovascular risk factors in the general population, being associated with high morbidity and socioeconomic burden. Diabetic cardiomyopathy (DCM) is a non-negligible complication of DM, whose pathophysiological fundaments are the altered cardiac metabolism, the hyperglycemia-triggered formation of advanced glycation end-products (AGEs) and the inflammatory milieu which are typical in diabetic patients. These metabolic abnormalities lead to cardiomyocytes apoptosis, interstitial fibrosis and mechanical cardiac dysfunction, which can be identified with non-invasive imaging techniques, like echocardiography and cardiac magnetic resonance. This review aims to: 1) describe the major imaging features of DCM; 2) highlight how early identification of DCM-related anatomical and functional remodeling might allow patients’ therapy optimization and prognosis improvement.

Purpose: The impact of dietary counseling on body composition in early breast cancer patients (EBC) treated with aromatase inhibitors (AIs) is uncertain. The aim of this study was to assess the effects of a diet counseling program on weight, BMI, total and regional body composition in patients treated with AIs. Methods: This observational study involved 194 EBC patients, of which 97 attended a 6-month personalized counseling program, based on Mediterranean diet principles (cohort A) and 97 did not (cohort B). Dual-energy X-ray absorptiometry (DXA) scan was used to measure the total and regional fat and lean body mass, before (baseline) and after at least 18 months of AI-therapy. Results: Weight and BMI increased significantly, on the average, in cohort B, but not in cohort A. In the cohorts A and B, fat mass increased by 10 % and 7.7 % respectively, while lean mass decreased by 3.3 % and 2.6 % from before to after AI therapy, without statistically significant differences between them using the Mann-Whitney test. The changes in body composition were greater in premenopausal than in postmenopausal women at cancer diagnosis. The proportion of patients with sarcopenia, obesity and sarcopenic obesity increased from before to after AI therapy, similarly in both cohorts. Conclusions: Patients treated with AIs reported an increase in fat mass and a decrease in lean mass, and consequently an increase in sarcopenia and obesity, regardless of the participation in a dietary counseling program. A combined dietary counseling and physical exercise program may be necessary for preventing these unfavourable changes in these patients.

Background: Depression that occurs in pregnancy or postpartum (perinatal depression) impacts 1 in 5 mothers, yet access to effective and high-quality preventative interventions remains elusive for most. Digital interventions are a promising solution to this treatment gap because of the ubiquity of mobile devices and internet access. The Mothers and Babies Online Course (eMB) is an online adaptation of Mothers and Babies, an evidence-based preventative program for postpartum depression. Preliminary studies of eMB point to its potential efficacy, but low engagement with eMB was a major limitation. Leveraging home visitors as coaches to guide clients through eMB may be a way to increase uptake and engagement, and ultimately improve outcomes when implemented in home visiting programs. Objective: The aim of this study was to implement user-centered design methods to develop a coaching manual for home visitors to implement eMB. Methods: 10 parents and 10 home visitors were interviewed individually. Measures included a “think aloud” activity and a semi-structured interview focused on gaining insight into parent and home visitor needs and preferences regarding eMB coaching in the context of home visiting. Thematic analysis was used to derive themes and sub-themes from interview transcripts. Results: Parents were enthusiastic about eMB, but noted barriers including limited time and forgetfulness. Parents also thought that their home visitor would be the ideal eMB coach because of the existing close relationship. Home visitors shared that eMB would fit seamlessly into their home visiting workflow. They also thought that home visitors could address challenges that parents encounter in using eMB and leverage their relationship with parents to crystalize learning. Home visitors also noted that a coaching manual would be a key part of successful eMB implementation. Thus, valuable insights from parents and home visitors were used to create a coaching manual. Conclusions: Parents and home visitors were both enthusiastic about eMB with adjunctive coaching, and home visitors agreed that a coaching manual would be vital in guiding them to help parents through eMB. Results highlight the importance of engaging end-users in all aspects of online intervention design, including the coaching manual. The effectiveness of the intervention and utility of the coaching protocol will be evaluated in a future pilot trial.

Objective: HPV vaccination is recommended for children beginning at age 9 to prevent several types of cancer. Many parents turn to Facebook for health information. This study describes changes in HPV vaccine-related articles shared on Facebook amidst the COVID-19 pandemic. Methods: HPV-related articles shared on Facebook (2019–2021) were collected using Buzzsumo, a social media analytics tool and analyzed using content analysis. Articles were categorized by valence, misinformation, evidence types, persuasive tactics, and framing. We quantified these data and tested for difference by article year. Results: Of the 138 included articles, 51% had positive valence towards the vaccine and 36% had negative valence. In 2021, there was a significant increase in positive messaging (72% vs. 44% in 2019/2020; p

Introduction: Drinking motives and neurocognition play significant roles in predicting alcohol use. There is limited research examining how relief-driven drinking motives interact with neurocognition in alcohol use, which would help to elucidate the neurocognitive-motivational profiles most susceptible to harmful drinking. This study investigated the interactions between neurocognition (response inhibition and cognitive flexibility) and relief-driven drinking, in predicting problem drinking. Methods: Participants completed the Alcohol Use Disorders Identification Test – Consumption items (AUDIT-C) to measure drinking behaviour, and online cognitive tasks, including the Value-Modulated Attentional Capture and Reversal Task (VMAC-R) and the Stop Signal Task (SST). The sample (N = 368) were individuals who drink alcohol, which included a subsample (N = 52) with problematic drinking, as defined by self-identifying as having a primary drinking problem. Drinking motives were assessed using a binary coping question in the overall sample, and the Habit, Reward, and Fear Scale (HRFS) in the subsample. Moderation analyses were conducted to investigate whether cognitive flexibility and response inhibition moderated relationships between relief-driven motives and drinking. Results: Cognitive flexibility moderated the relationship between relief-driven motives and drinking (overall sample: β = 13.69, p = 0.017; subsample: β = 1.45, p = 0.013). Greater relief-driven motives were associated with heavier drinking for individuals with low cognitive flexibility. There was no significant interaction between response inhibition and relief-driven motives. Conclusions: Relief-driven drinking motives interact with cognitive inflexibility to drive heavier drinking. Greater understanding of these neurocognitive-motivational mechanisms may help to develop more targeted and effective interventions for reducing harmful drinking.

Background: Risk factors for cardiovascular disease (CVD) and sleep health are well-known to be sex- and race-specific. To build on the established relationship between sleep duration and CVD risk, this cross-sectional study aimed to describe sex-specific associations between CVD risk and other sleep characteristics (sleep quality, sleep timing and sleep onset latency) in low-income adults of African descent. Methods: Self-reported sleep (Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]), demographic and lifestyle data were collected in 412 adults (56 % women, 35.0 ± 7.6y, 40 % employed) living in an informal settlement in South Africa. CVD risk was determined using the BMI-modified Framingham 10-year CVD risk formula. Results: Logistic regression analyses, adjusted for employment, alcohol use and physical activity, indicated that men reporting poor sleep quality (OR: 1.95[95 %CI: 1.07–3.51], p=0.025) and earlier bedtimes (0.54[0.39–0.74], p

Most aging populations report chronic illnesses, which are usually permanent or recurrent, significantly affect well-being and quality of life, require daily and consistent healthcare management, and last more than three months. Improved health outcomes and reduced healthcare costs are associated with self-care in treating chronic illnesses. The aim is to describe a protocol using a self-care intervention in a person with a chronic disease. A longitudinal study will be conducted with 40 patients. This article describes a protocol for a self-care intervention in a person with a chronic disease. The outcome measures will be compared with measures after the intervention in three different chronologic times. Randomization will be used to assign participants to the intervention group. The present study is expected to generate significant information about the role of self-care intervention in persons with chronic disease.

The implementation of rewilding initiatives is crucial for biodiversity recovery, particularly in biodiversity hotspots such as the Brazilian Atlantic Forest. Long-term monitoring of rewilding initiatives is critical for assessing progress and informing management choices. This study assesses the efficiency of different reforestation practices for biodiversity recovery, including passive restoration, active reforestation with different native seedlings, and plantations of exotic species. We applied an ecosystem approach to estimate the tree and mammal diversity, collected through forest plots and camera traps. We selected differently managed areas and included the oldest forest patches as reference points for the assessment of biodiversity; a naturally disturbed montane forest in the area was included as a control category for the disturbance analysis. Moreover, we investigated the influence of ecological variables, such as biodiversity, aboveground biomass, and altitude, on rewilding processes. Our results suggest that Eucalyptus plantations, a simplified ecosystem made up of monocultures of exotic species, support lower biodiversity. On the contrary, active reforestation with different native species resulted in an ecological status comparable to naturally regrown secondary forests. We show that active reforestation can reduce the time required for rewilding. We also found a positive correlation between tree and mammal species richness. These results underscore the importance and potential of responsible restoration efforts in recovering local biodiversity, contributing to the vision of a future where the Brazilian Atlantic Forest can be acknowledged not only as a biodiversity hotspot but also as a “hopespot.”

Fabry disease is a rare X-linked lysosomal condition that leads to the accumulation of glycosphingolipids in various tissues, causing cellular dysfunction, tissue remodeling, progressive fibrosis, and organ failure. The disease results from a deficiency in the human α-galactosidase A enzyme, responsible for breaking down glycosphingolipids like globotriaosylceramide (GL-3 or Gb3) into galactose and dihexose ceramides. In individuals diagnosed with Fabry disease, treatment from 2 years of age onwards typically involves agalsidase beta, the normal recombinant form of the defective enzyme. Agalsidase beta from Biosidus has been developed as a biosimilar to Sanofi-Genzyme's Fabrazyme®. In the molecule's clinical journey, a phase I trial was designed to establish its similarity in terms of pharmacokinetics, pharmacodynamics, and immunogenicity compared to the reference medication. The study was conducted on 24 healthy male volunteers, aged between 18 and 40 years. All volunteers received a single 1 mg/kg bw dose of Fabrazyme® or Biosidus Agalsidase beta by continuous intravenous (IV) infusion over 5 h. The 90 % confidence interval (CI) of the maximum concentration (Cmax), area under the plasma concentration-time curve from time 0 to 12 h (AUC0-12 h) and area under the plasma concentration-time curve extrapolated from time 0 to infinity (AUC0-∞) ratios fell within the accepted range of 80–125 %. No differences were detected in adverse effects or antibody induction. This indicates that Biosidus agalsidase beta meets the criteria for being considered similar to the reference formulation Sanofi Genzyme's Fabrazyme®.

While the medical community continues to recognize the contributions of disordered sleep to the burden of Prader-Willi syndrome (PWS), the medical literature lacks characterization of the patient burden of sleep disorders by people living with PWS and their caregivers. We developed and fielded a 72-question survey to the online PWS community, to query caregivers about their experiences with sleep symptoms. Respondents for all age groups reported sleep-disordered breathing (40 %), cataplexy-like symptoms (28.4 %), and insomnia (43.5 %). The presentation of cataplexy-like symptoms tended to change as children aged, presenting initially (ages 0–4 years) as head bobbing while eating, then transitioning to knee buckling between the ages of 5–12 years. Finally, loss of generalized tone associated with extreme emotions became more common in the teenage years. Frequent screening for potentially treatable sleep disorders should be considered the standard of care for individuals with PWS.

With age, adolescents increasingly demonstrate the ability to forgo immediate, smaller rewards in favor of larger delayed rewards, indicating reduced delay discounting. Adolescence is also a time of social reorientation, where decisions not only involve weighing immediate against future outcomes, but also consequences for self versus those for others. In this functional Magnetic Resonance Imaging study, we examined the neural correlates of immediate and delayed reward choices where the delayed outcomes could benefit self, friends, or unknown others. A total of 196 adolescent twins aged 14–17 completed a social delay discounting task, with fMRI data acquired from 174 participants. Out of these, 156 adolescents had valid fMRI data, and 138 adolescents had observations in every condition. Adolescents more often chose the immediate reward when it was larger, and when the delay was longer. Area-under-the-curve (AUC) comparisons revealed that behavior differed across delay-beneficiaries, with AUC being highest for the self, followed by friends, and lowest for unknown others. This suggests that adolescents are more willing to wait for rewards for self. Neuroimaging analyses showed increased activity in the midline areas medial prefrontal cortex (MPFC) and precuneus, as well as bilateral temporal parietal junction (TPJ) when considering delayed reward for unknown others and friends compared to self. A whole-brain interaction with choice showed that the bilateral insula and right dorsolateral prefrontal cortex (DLPFC) were more active for delayed choices for unknown others and for immediate choices for friends and self. This underscores that the neuro-cognitive processing of how delays reduce the value of rewards depends on closeness of the beneficiary.

Background & Aims: Patients with vascular liver diseases (VLD) are at higher risk of both severe courses of COVID-19 disease and thromboembolic events. The impact of SARS-CoV-2 vaccination in patients with VLD has not been described and represents the aim of our study. Methods: International, multicenter, prospective observational study in patients with VLD analyzing the incidence of COVID-19 infection after vaccination, severity of side effects, occurrence of thromboembolic events and hepatic decompensation. In a subgroup of patients, the humoral and cellular responses to vaccination were also analyzed. Results: A total of 898 patients from 14 European centers – part of the VALDIG network – were included, 872 (97.1%) patients received two vaccine doses (fully vaccinated), and 674 (75.1%) three doses. Of the total cohort, 151/898 had a COVID-19 infection prior to vaccination, of whom 9/151 (5.9%) were re-infected. Of the 747/898 patients who were not previously infected, 11.2% (84/747) were diagnosed with a COVID-19 infection during the study period. Two infected patients required intensive care unit admission and infection was fatal in two fully vaccinated patients. Adverse effects were reported in around 40% of patients, with local side effects being the most frequent. During the study period, 31 (3.5%) patients had thromboembolic events and 21 (2.3%) hepatic decompensations. No cases of vaccine-induced thrombocytopenia were reported. Vaccine immunogenicity was assessed in 36 patients; seroconversion reached 100% and IFNy T-cell responses significantly increased post two mRNA-1273 vaccine doses. Conclusion: Patients with VLD seem to have a preserved immune response to SARS-CoV-2 vaccination, which appears to be safe and effective in preventing severe COVID-19 infection. Our study cannot definitively establish a direct link between vaccination and thrombotic events, though the contribution of vaccination as a cofactor in VLD remains to be elucidated. Impact and implications:: Patients with vascular liver disease (VLD) are at increased risk of both SARS-CoV-2 infection and severe COVID-19 disease. The potential risks associated with vaccination against this infection need thorough investigation. Our research enhances the understanding of the effects of COVID-19 vaccination in patients with VLD, highlighting its good tolerability. Moreover, patients with VLD appear to have a preserved immune response to SARS-CoV-2 vaccination, providing protection against severe COVID-19 infection. Our study cannot definitively establish a direct link between vaccination and thrombotic events, and no cases of vaccine-induced thrombocytopenia were reported.

Resumen: Antecedentes y objetivos: El desarrollo de lesión renal aguda (FRA) durante la hospitalización por SARS-Cov-2 se ha asociado a una elevada morbimortalidad. El Registro FRA-COVID SEN ha recogido datos de pacientes con este perfil durante los meses de la pandemia. El objetivo de este trabajo fue caracterizar la población española ingresada por COVID-19 que desarrolló FRA, con/sin necesidades de tratamiento renal sustitutivo (TRS), modalidades terapéuticas utilizadas y resultados en términos de mortalidad. Material y método: Estudio retrospectivo de datos procedentes de 30 hospitales españoles, recopilados en el Registro español FRA COVID desde mayo de 2020 hasta noviembre 2021. Se registraron variables clínicas y demográficas, datos relacionados con la gravedad de la COVID-19, con el FRA y de supervivencia. Mediante estudio de regresión multivariante se analizan los factores relacionados con la necesidad de TRS y con la mortalidad. Resultados: Se registraron datos de 730 pacientes. El 71,9% eran hombres, con edad media de 70 años (60-78). El 70,1% eran hipertensos, el 32,9% diabéticos, el 33,3% con enfermedad cardiovascular y el 23,9% presentaban algún grado de enfermedad renal crónica. Desarrollaron neumonía el 94,6%, con necesidad de soporte ventilatorio en el 54,2% e ingreso en UCI en un 44,1% de los casos.La mediana de tiempo desde el inicio de los síntomas de COVID hasta la aparición de FRA fue de 6 días (4-10). En cuanto a la gravedad: 37,1% KDIGO I, 18,3% KDIGO II y 44,6% KDIGO III; requirieron TRS 235 pacientes (33,9%). Las técnicas continuas (TCRR) fueron las más empleadas (155 pacientes), seguidas de hemodiálisis (HD) intermitente (89 pacientes), HD diaria (36 pacientes), hemodiafiltración (HDF) 17 pacientes y HD expandida (HDexp) en 24 casos. El hábito tabáquico (OR 3,41), la necesidad de soporte ventilatorio (OR 20,2), la cifra de creatinina máxima (OR 2,41) y el tiempo transcurrido desde el inicio de los síntomas hasta la aparición del FRA (OR 1,13) se identificaron como predictores de la necesidad de TRS en nuestra cohorte, mientras la edad se comporta como protector (OR: 0,95). El grupo que no requirió TRS se caracterizó por presentar mayor edad, menor gravedad de FRA y un tiempo de aparición y recuperación de la lesión renal más corto (p

Background: COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a relatively common complication. Multiple studies described this relationship in critical patients, however its incidence and outcome in other risk groups such as immunosuppressed patients remains unknown. In this sense, we aimed to evaluate the rates and outcomes of CAPA in hematological patients and according to the different hematological malignances, comparing to invasive pulmonary aspergillosis (IPA) in non-COVID-19 ones. Methods: Nationwide, population-based and retrospective observational cohort study including all adult patients with hematological malignancies admitted in Spain since March 1, 2020 to December 31, 2021. The main outcome variable was the diagnosis of IPA during hospitalization in hematological patients with or without COVID-19 at admission. The rate of CAPA compared to IPA in non-COVID-19 patients in each hematological malignancy was also performed, as well as survival curve analysis. Findings: COVID-19 was diagnosed in 3.85 % (4367 out of 113,525) of the hematological adult inpatients. COVID-19 group developed more fungal infections (5.1 % vs. 3 %; p

Summary: Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (

This research examines the impact of COVID-19 on Spanish international tourism, focusing on the routes of access to the country. Using data from October 2015 to March 2024, a counterfactual analysis was conducted to calculate the severity of the impact on Foreign Tourism Access to Spain by Air Transport, Road, Railway, and Maritime Transport. Benchmark series were calculated using the SARIMA model and validated with Machine Learning methods. Results show significant increases in Air and Road access post-pandemic, with even larger increases in Railway and Maritime routes, indicating early recovery trends since May 2023. These findings highlight the need for adaptive marketing strategies to align with new travel preferences for sustainable and health-conscious travel options.

Klinefelter Syndrome (KS) is an aneuploid genetic condition in males characterized by at least one additional copy of the X chromosome. Due to fibrotic degeneration of the testis, these patients suffer infertility in the future. The pathogenic mechanism by which this occurs is still not well known. Here, we establish three Induced Pluripotent Stem cell (iPSC) lines derived from prepuberal and peripuberal KS patient’s testicular somatic cells. These could be the first steps towards the creation of an in vitro platform to analyze the molecular mechanisms underlying pathophysiology of the testes in KS patients.

Toxic shock syndrome secondary to Group A Streptococcus infection is a rare but serious cause of women's morbidity and mortality which can easily be misdiagnosed. A 37-year-old woman presented to the emergency department in a state of shock after a two-day history of abdominal pain, fever, diarrhoea and green vaginal discharge. Following extensive investigations, she was proved to have septic shock secondary to Group A Streptococcus pyogenes. Despite receiving intravenous antibiotics, she required explorative laparotomy, which proceeded to subtotal hysterectomy and bilateral salpingectomy. Subsequently, she developed multi-organ failure, disseminated intravascular coagulation, and limb ischemia requiring below-knee amputation of the right limb. She was discharged home. The aim of this report is to raise the awareness about toxic shock syndrome from Streptococcus pyogenes. A high index of suspicion is required to promptly diagnose this rare yet potentially fatal infection.

Background: Disasters, both natural and human-made, universally affect communities and are recognized as major environmental and global challenges. Aim: This study seeks to investigate the specific academic challenges faced by nursing students during flood disasters at a university in Dagupan City. It also seeks to compare the academic performance of these students during and after the flood season. Design: Descriptive-comparative study. Settings: A private university in Dagupan City, known for its flooding susceptibility, hosted the study. Participants: A total of 236 nursing students participated in the study. Methods: For data collection, the study adopted a total enumeration approach, categorizing the data into archived and survey categories. The study utilized descriptive statistics like frequency, percentage, mean, and standard deviation. Paired sample t-tests were conducted to evaluate differences in academic performance during and after the flood. Results: Flood-related disruptions, including class suspensions and academic difficulties, affected many nursing students. The floods led to reduced study hours, unavoidable absences, and health risks, all of which detrimentally impacted their academic achievements. Additionally, transportation disruptions significantly hindered educational activities. After the disaster, the students' academic performance improved noticeably. Conclusions: Flooding profoundly affects the educational journey of nursing students, impairing both their academic outcomes and overall health. Despite these challenges, the students demonstrated remarkable resilience by improving their academic performance post-disaster. This improvement underscores the importance of robust support systems, including disaster-related health education and flexible academic policies to manage unexpected disruptions. The observed post-flood academic recovery attests to the effectiveness of educational institutions' rehabilitation and support strategies.

Chordomas are a rare slow growing tumor with a high recurrence rate that originate from residual embryonic notochord cells, primarily affecting the axial skeleton. Currently limited treatment options exist beyond surgery and radiation, and systemic chemotherapy has shown limited efficacy. The majority of chordomas exhibit negative thymidylate synthase (TS) expression, implying a potential responsiveness to the antifolate agent pemetrexed. We present a case report of a 78-year-old patient with recurrent, metastatic sacral chordoma who showed clinical and radiological improvement with pemetrexed treatment. The patient received 12 cycles of pemetrexed which resulted in a decrease in the size of liver and lung lesions. Moreover, the patient experienced resolution of debilitating symptoms, including right leg weakness, and unsteady gait. This case report highlights the use of pemetrexed as a therapeutic option for recurrent and metastatic chordoma. Further research is warranted to explore the optimal use of pemetrexed in chordoma management and identify predictive biomarkers for treatment response.

Ecosystem functions such as biological pest control are mediated by the richness and abundance of service providers i.e., biological control agents (BCAs), relative contributions of individual taxa and community structure. This is especially relevant in the native range of agricultural herbivores, where a speciose community of co-evolved BCAs can prevent them from attaining pest status. Here, we use a powerful graphical approach to assess the functional structure of BCA communities of the fall armyworm (FAW) Spodoptera frugiperda (Lepidoptera: Noctuidae) on maize in the Neotropics. Drawing upon a curated database of all-time field and laboratory studies, we graphed patterns in the functional contribution, abundance and niche breadth for a respective 69, 53 and 3 taxa of resident parasitoids, predators and pathogens. Regardless of varying taxon coverage and rigor of the underlying studies, functional structure follows a saturating relationship in which the first three taxa account for 90–98% of aggregate biological control function. Abundance-functionality matrices prove critically incomplete, as more than 80% of invertebrate taxa miss empirically derived efficiency metrics while associated FAW infestation data are scarce. Despite its methodological shortfalls and data gaps, our work pinpoints Chelonus insularis, several taxa of egg parasitoids, Doru spp. and Orius spp. as taxa with outsized (average) functionality and conservation potential. This is also exemplified by the highly variable aggregate function across studies, with dispersion indices of 1.52 and 2.14 for invertebrate BCAs. Our work underlines the critical importance of functional ecology research, networked trials and standardized methodologies in advancing conservation biological control globally.

Summary: Background: Transportation noise has been linked with cardiometabolic outcomes, yet whether it is a risk factor for atrial fibrillation (AF) remains inconclusive. We aimed to assess whether transportation noise was associated with AF in a large, pooled Nordic cohort. Methods: We pooled data from 11 Nordic cohorts, totaling 161,115 participants. Based on address history from five years before baseline until end of follow-up, road, railway, and aircraft noise was estimated at a residential level. Incident AF was ascertained via linkage to nationwide patient registries. Cox proportional hazards models were utilized to estimate associations between running 5-year time-weighted mean transportation noise (Lden) and AF after adjusting for sociodemographics, lifestyle, and air pollution. Findings: We identified 18,939 incident AF cases over a median follow-up of 19.6 years. Road traffic noise was associated with AF, with a hazard ratio (HR) and 95% confidence interval (CI) of 1.02 (1.00–1.04) per 10-dB of 5-year mean time-weighted exposure, which changed to 1.03 (1.01–1.06) when implementing a 53-dB cut-off. In effect modification analyses, the association for road traffic noise and AF appeared strongest in women and overweight and obese participants. Compared to exposures ≤40 dB, aircraft noise of 40.1–50 and > 50 dB were associated with HRs of 1.04 (0.93–1.16) and 1.12 (0.98–1.27), respectively. Railway noise was not associated with AF. We found a HR of 1.19 (1.02–1.40) among people exposed to noise from road (≥45 dB), railway (>40 dB), and aircraft (>40 dB) combined. Interpretation: Road traffic noise, and possibly aircraft noise, may be associated with elevated risk of AF. Funding: NordForsk.