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Globally, the number of citizen science clean-up projects, such as beach cleans, is increasing in an effort to reduce the amount of plastic pollution in the environment. Such activities offer the opportunity to gather insightful data on plastic abundance, distribution and composition. This information is key for informing effective management strategies aimed at reducing input but little work has been conducted to examine the challenges faced by existing citizen science projects, or the potential opportunities for maximising their impact. Here, we present the results of a questionnaire survey and follow-up workshop to explore the opinions of representatives from 20 organisations that deal with the issue of plastic pollution in the environment. Our results show that, of the organisations that conduct clean-up activities in the United Kingdom (UK), the majority collect data on plastic pollution to some extent. To ensure these data are scientifically meaningful and the necessary levels of public engagement are maintained, participants felt that survey protocols should be standardised across organisations and data submission should be as simple and easy as possible. The participants considered communication, inclusivity and volunteer diversity to be key for enhancing citizen engagement and improving data quality. Many organisations were unclear about how the information they hold can be most effectively used to help inform policies relating to managing plastic pollution. Moving forwards, there is a clear desire from clean-up organisations to collaborate with other sectors, such as commercial, policy, waste and recycling, education and technology stakeholders, as well as other non-governmental organisations and scientific researchers, to enhance the value and impact of citizen science in tackling the issue of plastic pollution.

A growing body of evidence supports the efficacy and safety of bariatric surgery for clinically severe obesity. Despite this empirical support, bariatric surgery remains profoundly underutilized. The reasons for underutilization are likely multifactorial, including health insurance coverage and benefits design, lack of awareness about bariatric surgery by patients, and anecdotal concerns about safety. We believe that there are two other factors-the occurrence of weight stigma and bias and suboptimal communication between patients and providers-that also serve as barriers to greater utilization. The article reviews the existing literature related to these two factors. The review also highlights the science of shared medical decision-making as a potential strategy to promote appropriate conversations between patients and providers, both surgical and nonsurgical, about the efficacy and safety of bariatric surgery. Shared medical decision-making is used in other areas where complex medical decisions are required. We believe that it has great potential to contribute to the increased utilization for the millions of individuals who could benefit from bariatric surgery.

Statement of problem Denture base resins (DBRs), such as polymethyl methacrylate, are commonly used in the fabrication of removable dentures because of their physical, mechanical, and esthetic properties. However, the denture base acts as a substrate for microorganism adherence and biofilm formation, which may lead to denture stomatitis and be further complicated by fungal infections, of especial importance with geriatric and immunosuppressed patients. Therefore, methods to enhance the antimicrobial property of DBRs will be beneficial. Purpose The purpose of this systematic review was to evaluate the literature on the antimicrobial activity of DBRs incorporating antimicrobial agents or materials. Material and methods A search of English peer-reviewed literature up to February 2019 reporting on antimicrobial activity of DBRs with respect to antimicrobial agents or materials, antimicrobial test effects and methods, and conclusion or knowledge gaps was conducted by using Embase, Google Scholar, PubMed, and Web of Science databases. Search terms included denture base resin and antibacterial, denture base resin and antifungal, and denture base resin and antimicrobial. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied for subsequent data analysis. Results Of 2536 identified articles, 28 met the inclusion criteria for the systematic review. Antimicrobial materials were divided into 3 groups: antimicrobial monomer or copolymer, phytochemical or phytomedical components, and other compounds. Strategies on how to incorporate these substances into DBRs and their impact on the reduction and prevention of the growth of microorganisms were identified. Conclusions Although many efforts have been made to improve the antimicrobial ability of DBRs, this systematic review found that the effectiveness of incorporating of antimicrobial agents into DBRs has not been demonstrated conclusively.

American cities have played an increasingly critical role in advancing US climate change mitigation and adaptation. Subnational government support for these efforts, however, varies across social, political, economic, and biogeophysical contexts. While the influence of politics on US climate mitigation is well established, further research is required to identify barriers to—and discern complex influences on—US subnational climate action. This study examines the influences of power dynamics between public and private interests, political party affiliation within government and the public, and risk of climate impacts, on observed climate mitigation and adaptation efforts within 136 urban US cities and 33 states. The findings of this study shed light on the motivations of subnational governments to take climate action, and identify significant dynamics influencing the likelihood of key state or local government decision-makers to take climate action.

Summary Background COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years. Methods Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic. Findings In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics. Interpretation Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic. Funding Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.

Calcium phosphate (CaP) coating on melt electrowritten (MEW) substrates is a potential candidate for bone regeneration influencing the interaction of osteoblasts with implanted scaffolds. Pretreatment to improve hydrophilicity of the hydrophobic polymer fibres affects subsequent coating with bioactive compounds like CaP. Therefore, this study evaluated the subsequent stability and structural properties of CaP coated MEW Poly-ε-caprolactone (PCL) scaffolds following pre-treatment with either argon-oxygen plasma or sodium hydroxide (NaOH). Scanning electron microscopy and μ-CT showed uniform CaP coating after one hour immersion in simulated body fluid following plasma pretreatment. Moreover, fourier transform infrared spectroscopy, energy dispersive spectrometry and X-ray diffraction analysis confirmed the presence of hydroxyapatite, tetracalcium phosphate and halite structures on the coated scaffolds. Contact angle measurement showed that the plasma pretreatment and CaP coating improved the hydrophilicity of the scaffold. However, the mechanical properties of the scaffolds were degraded after both plasma and NaOH treatments. The tensile stability was significantly improved following mineralization in plasma-treated scaffolds due to the smaller crystal size formed on the surface resulting in a dense CaP layer. The results obtained by thermogravimetric analysis also confirmed higher deposition of CaP particles on coated scaffolds following plasma modification. The results of this study show that plasma pre-treated mineralized MEW PCL scaffolds are sufficiently stable to be useful for further development in bone regeneration applications. Keywords: Calcium phosphate coating, Polycaprolactone, Melt electrowriting, Apatite mineralization, Plasma treatment, Bone regeneration

Decellularised tissues and organs have been successfully used in a variety of tissue engineering/regenerative medicine applications. Because of the complexity of each tissue (size, porosity, extracellular matrix (ECM) composition etc.), there is no standardised protocol and the decellularisation methods vary widely, thus leading to heterogeneous outcomes. Physical, chemical, and enzymatic methods have been developed and optimised for each specific application and this review describes the most common strategies utilised to achieve decellularisation of soft and hard tissues. While removal of the DNA is the primary goal of decellularisation, it is generally achieved at the expense of ECM preservation due to the harsh chemical or enzymatic processing conditions. As denaturation of the native ECM has been associated with undesired host responses, decellularisation conditions aimed at effectively achieving simultaneous DNA removal and minimal ECM damage will be highlighted. Additionally, the utilisation of decellularised matrices in regenerative medicine is explored, as are the most recent strategies implemented to circumvent challenges in this field. In summary, this review focusses on the latest advancements and future perspectives in the utilisation of natural ECM for the decoration of synthetic porous scaffolds.

This paper describes a new radio frequency timer of keV energy electrons. It is based on a helical deflector, which performs circular or elliptical sweeps of keV electrons, by means of 500 MHz radio frequency field. By converting a time distribution of incident electrons to a hit position distribution on a circle or ellipse, this device achieves extremely precise timing. Streak Cameras, based on similar principles, routinely operate in the ps and sub-ps time domain, but have substantial dead time associated with the readout system. Here, we report a new type of RF timing technique, where the position sensor, consisting of microchannel plates and a delay-line anode, produces ~ns duration pulses with small dead time. Measurements made with sub-ps duration laser pulses, synchronized to the radio frequency power, produced a timing resolution of ~10 ps. This ultra-high precision technique has potential applications in a large variety of scientific devices, and in all cases, electrons are timed and detected simultaneously in the same device., 12 pages, 7 figures

Background Gavi, the Vaccine Alliance, delivers life-saving vaccines to children in the world’s poorest countries and encourages countries to assume increasing ownership of their immunization programs as their economies grow. Vaccination legislation may promote country ownership and immunization program sustainability. However, despite establishment of vaccination laws as an indicator of national commitment to immunization through the Global Vaccine Action Plan, little is known about the content of vaccination legislation in low- and middle-income countries and the processes by which countries strengthen their legal frameworks. We describe the experiences of three countries supported by Gavi through its partnership with the Sabin Vaccine Institute— Armenia, Georgia, and Moldova—in strengthening their legal frameworks for vaccination as they transition from Gavi support. Methods Information presented comes from national legal documents and the 2017 European Regional Workshop on Immunization Legislation, in which legislators and health officials from Armenia, Georgia, and Moldova shared approaches to making immunization a national priority by strengthening legal frameworks. We outline each country’s legislative framework, describe progress in modifying vaccination legislation, and present strategies developed by countries to continue strengthening the legal basis of their immunization programs. Results Armenia, Georgia, and Moldova have legal frameworks that guarantee immunization as a public good, define immunization calendars, and establish regulations for vaccine procurement and administration. Legislative priorities include modifications of regulations to optimize procurement (Armenia and Moldova), potential provisions to increase vaccination through incentives (Georgia) or requirements (Moldova, possibly Armenia), and new mechanisms to finance routine program costs (all three countries). Each country is employing a distinct approach to strengthen its legal framework. Conclusion These country experiences suggest that while legal approaches can promote country ownership, there is no standardized approach to vaccination legislation. A better understanding of the complex legal frameworks and their impact on supporting and sustaining progress in vaccination is needed.

The proliferation of silver nanoparticles (AgNPs) in the environment and resultant transport into aquatic systems have raised concerns regarding their potential toxicity to various organisms. These environmental and ecological concerns demand reliable AgNP detection methods which can measure environmentally relevant quantities of AgNPs in real aquatic systems. This study developed a method that couples a rapid vacuum filtration technique with a portable Raman spectrometer to achieve on-site detection of ultra-low levels of AgNPs in typical and complex aquatic systems. To extract and detect AgNPs, aluminum chloride and ferbam were added for AgNP aggregation and labelling, respectively. The AgNP aggregates were filtered through a membrane, and their presence and quantity were determined based upon the surface-enhanced Raman scattering (SERS) peak intensity of ferbam. Under the optimized conditions, the extraction efficiencies are 99 ± 0.001% in ultrapure water and 98 ± 0.025% in marine water for 1 mg/L AgNPs. This method enables simple volume adjustment and improves the consistency of AgNP distribution on the membrane. The performance of the method was evaluated in different environmental waters, including marine water, fresh waters (pond water, river water, and reservoir outlet water) and drinking waters (municipal tap water and well water), with highest signal intensity in marine water and lowest signals in fresh waters. The signal intensity difference was suggested to be caused by the amount of natural organic matter (NOM) in these environmental waters. Using pond water as an example, the interference was minimized by changing the aggregating salt from AlCl3 to MgCl2, and AgNPs as low as 5 μg/L were reliably detected with a volume of 100 mL. At the same volume, the developed method was sensitive enough to detect 1 μg/L AgNPs in marine water and also holds promise for assessing the time-dependent transformation of AgNPs.

Analyzing future changes in hydrologic extremes such as floods, low flows, and soil moisture extremes is important because many impacts on ecosystems and human systems occur during extreme events. To quantify changes in hydrologic extremes, this study conducts hydrologic modeling experiments over 20 Midwestern watersheds using the Variable Infiltration Capacity (VIC) model forced by historical observed datasets and future projections from statistically downscaled Global Climate Model (GCMs) simulations. Our results show that peak daily streamflow at the 100-yr reoccurrence interval will increase (+10–30%) in most watersheds by 2080s due to significant increases in precipitation (P) and increasing P as rainfall during winter and spring seasons. The simulations also show strong shifts towards earlier peak flow timing (up to a month), especially in strongly snowmelt-dominated watersheds. These effects are linked to strong decreasing trends in maximum Snow Water Equivalent (SWE) with warming, which are simulated over essentially the entire domain. Projected changes in 7-day extreme low flows are smaller in magnitude (−10–+10%) with somewhat larger decreases simulated at the end of century; however, the timing of extreme low flows is projected to shift from winter/spring to summer and fall in strongly snowmelt-dominated watersheds in the northernmost parts of the domain. Extreme low soil moisture increases over most of the domain in the future projections up to the 2050s, but by the 2080s there are more widespread decreases in extreme low soil moisture, especially in the northernmost parts of the domain.

Despite the effectiveness of bariatric surgery, both with respect to weight loss and improvements in obesity-related co-morbidities, it remains underused. Only 1% of the currently eligible population undergoes surgical treatment for obesity, with roughly 228,000 individuals receiving bariatric surgery in the United States each year. Several barriers to bariatric surgery have been identified, including limited patient and referring physician knowledge and attitudes regarding the effectiveness and safety of bariatric surgery. However, the role of insurance coverage and benefit design as a barrier to access to care has received less attention to date. Bariatric surgery is cost-effective compared with nonsurgical treatments among individuals with extreme obesity and type 2 diabetes. While it may not result in cost savings among all bariatric surgery eligible patients, for certain patient subgroups, bariatric surgery may be cost neutral compared with traditional treatment options. In addition, longer-term outcomes of bariatric surgery suggest decreased or stable costs in the long run. The purpose of this review paper was to synthesize the existing knowledge on why bariatric surgery remains largely underused in the United States with a focus on health insurance benefits and design. In addition, the review discusses the applicability of value-based insurance design to bariatric surgery. Value-based insurance design has been previously applied to bariatric surgery coverage with use of incentive-based cost-sharing adjustments. Its application could be further extended because the postoperative clinical outcomes and costs vary among the different subgroups of bariatric surgery eligible patients.

Despite the potential negative impact of facial palsy, major gaps in understanding persist surrounding the treatment and care of those affected. This collaborative three-round Delphi process aimed to identify priorities for future facial palsy research, from the perspective of clinicians, researchers, patients and carers. It also determined whether the research priorities of patients and carers aligned with those of health professionals and researchers. In Round 1, participants (n = 85) were asked to generate research questions by focus groups or an online or postal survey. In Rounds 2 (n = 72) and 3 (n = 78), participants were asked to rate the priorities identified on a 5-point ordinal scale. Thirty-six questions reached the definition of 'high priority' consensus. Seven of each groups' top ten research priorities were shared. Prioritised questions included the provision and pathways of care, the psychosocial impact of living with facial palsy and the effective management of side effects. Establishing the research priorities in the field of facial palsy is a significant first step in ensuring that the future research agenda is focussed on topics that are considered important by both patients and health professionals.

In the Caribbean region, there is a significant yearly number of natural events incidents. The impact of those events has affected the well-being, social and economic structures of the countries in this region. The investment in disaster management strategies is a fundamental decision to the region for improving capabilities, understanding the liabilities, dealing with the disaster stages, and integrating systems and tools to obtain greater results in resilience strategies. Therefore, information technology and robotics have played an effective role bringing innovation to the traditional approaches by improving the capabilities of personnel and serving as a catalyst to rapid data collection tools for effective decision-making during disastrous situation, as has been the case of the Dominican Republic. The organic adoption process of Unmanned Aerial System (UAS) has represented a large step forward regarding this matter. Examples of the adoption process occur based on their flexibility in their regulatory context, funding investments in testing the applications of UAS, such as surveying, delivering medical samples and spray disinfection during the COVID-19 pandemic. However, there are only some mature applications that address a future-proofing concept as well as the integration into a typical institutional workflow. Therefore, this paper aims to be an introductory guide for decision and policymakers, educators and technicians to reduce the scepticism, lack of knowledge and know-how in the adoption of reliable, practical and effective tools by providing a combination of theories from socio-technical systems (socio-technical change impact model (SCI)) and organisational level (technology-organisational-environmental) frameworks of the UAS adoption process for natural events, tasks and critical roles in disaster management taking into account the Dominican Republic context. Qualitative case of study was evaluated from 7 organisations involved to disaster management in the Dominican Republic, and a semi-structured interview were used to approach the adoption process of Unmanned Aerial System (UAS) in these organisations. The findings of these studies reveal the lessons learned from the internal strategies and policies in the adoption process between public and private institutions. The task of capturing images and videos has been shown to be a faster way to acquire data, which allow infrastructure projects to tend to be a significant benefit at the moment of applying UAS for 3D reconstructions and simulations of seismic behaviour, and finally, identification of inaccessible vulnerable areas after disasters. Other tasks, such as search and rescue, are also mentioned. Recommendations for policymakers are related to establish guidance for learning organisations approaches on focusing on digitalisation of cities through UAS applications. Other context can be benefit from the lessons and can also beas an additional complement of the Regional Comprehensive Disaster Management Framework of 2014–2024.

Background: In the face of rapidly changing data, a range of case fatality ratio estimates for coronavirus disease 2019 (COVID-19) have been produced that differ substantially in magnitude. We aimed to provide robust estimates, accounting for censoring and ascertainment biases. Methods: We collected individual-case data for patients who died from COVID-19 in Hubei, mainland China (reported by national and provincial health commissions to Feb 8, 2020), and for cases outside of mainland China (from government or ministry of health websites and media reports for 37 countries, as well as Hong Kong and Macau, until Feb 25, 2020). These individual-case data were used to estimate the time between onset of symptoms and outcome (death or discharge from hospital). We next obtained age-stratified estimates of the case fatality ratio by relating the aggregate distribution of cases to the observed cumulative deaths in China, assuming a constant attack rate by age and adjusting for demography and age-based and location-based under-ascertainment. We also estimated the case fatality ratio from individual line-list data on 1334 cases identified outside of mainland China. Using data on the prevalence of PCR-confirmed cases in international residents repatriated from China, we obtained age-stratified estimates of the infection fatality ratio. Furthermore, data on age-stratified severity in a subset of 3665 cases from China were used to estimate the proportion of infected individuals who are likely to require hospitalisation. Findings: Using data on 24 deaths that occurred in mainland China and 165 recoveries outside of China, we estimated the mean duration from onset of symptoms to death to be 17·8 days (95% credible interval [CrI] 16·9–19·2) and to hospital discharge to be 24·7 days (22·9–28·1). In all laboratory confirmed and clinically diagnosed cases from mainland China (n=70 117), we estimated a crude case fatality ratio (adjusted for censoring) of 3·67% (95% CrI 3·56–3·80). However, after further adjusting for demography and under-ascertainment, we obtained a best estimate of the case fatality ratio in China of 1·38% (1·23–1·53), with substantially higher ratios in older age groups (0·32% [0·27–0·38] in those aged Interpretation: These early estimates give an indication of the fatality ratio across the spectrum of COVID-19 disease and show a strong age gradient in risk of death.