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The EU Treaties contain no provision akin to the clause in the United States Constitution empowering spending in the 'general Welfare', i.e., for the general public good. Nonetheless, supporters of a broad reading of the cohesion flexibility clause, Article 175(3) TFEU, now claim that the EU, in effect, already has that power. The claim is inspired by that clause serving as the sole legal basis for the Recovery and Resilience Facility (RRF). This is the cornerstone of the NextGenerationEU (NGEU) Programme, the EU's massive borrowing and spending initiative that has directed a large amount of money to national priorities to address not just economic consequences of Covid but also longer-term issues of climate change, energy transition, and digitalization. This contribution critically assesses whether Article 175(3) TFEU can serve as the basis for general spending authority in the EU, particularly at the expense of its traditional role in regional development in Europe's economic periphery. The analysis draws on the historic purposes of cohesion policy, the existing case law on the limited scope of the cohesion flexibility clause, as well as legal opinions of the Council Legal Service on the same question. This contribution concludes that the crisis-driven reinterpretation of Article 175(3) TFEU not only undermines cohesion as developmental tool for the periphery, but it also raises serious concerns about democratic legitimacy and the rule of law at Europe's core. The EU may well need a general spending power, but the way to achieve it is not through institutional lawyers engaging in strained crisis reinterpretation outside of public scrutiny. Instead, what is needed is democratic politics pure and simple, i.e., Treaty change. [ABSTRACT FROM AUTHOR]

Outgroup and diversity attitudes are important components of intercultural understanding and well-being. Despite the potential of ethnic-racial identity development as a means to foster positive outgroup and diversity attitudes, little is known about its effectiveness in rapidly diversifying contexts such as Sweden. This pre-registered study filled this gap by examining if adolescents taking part in an intervention focused on ethnic-racial identity exploration, the Identity Project, also reported change in outgroup and diversity attitudes, and whether migration background, education type, and ethnic-racial identity development predicted such change. Twenty-three tenth-grade classes in Sweden (N = 509; Mage = 16.28; SDage = 0.80; 66% female; 51% migration background) participated in the intervention and were assessed in four waves over a period of 26 weeks. Whereas ethnic-racial identity exploration and resolution increased for the intervention group, the adolescents reported no change in outgroup and diversity attitudes when compared to a control group. Increases in ethnic-racial identity exploration and resolution co-varied with increases in attitudes, but only at Time 3. The results do not provide support for the link between ethnic-racial identity development and positive outgroup and diversity attitudes, and challenge the notion of attitude change as a cascading effect of the Identity Project intervention in non-US sociocultural contexts. All aspects of the study were pre-registered on the Open Science Framework platform (https://osf.io/f5896). [ABSTRACT FROM AUTHOR]

Wood is an important construction material, but a significant problem hindering its widespread use is susceptibility to biodeterioration and biodegradation. To protect wood against degradation, a surface coating can be used, and it is important to be able to predict the ability of the coating to prevent fungal growth. The currently available standard method to determine the antifungal efficiency of a coating has two weaknesses, viz. no evaluation of the moisture content in the wood material, and no possibility to study antifungal effect of the coating towards an individual fungus. A new quantitative method of determining the antifungal efficiency of coatings is therefore proposed, where a coating is applied to wood and exposed to an individual fungus in a Petri dish. Six commercial water-based coatings containing synthetic biocides were studied on filter paper (EN 15457) and with the new test method on wood blocks. The results show the importance of studying the antifungal efficiency of a coating using individual fungi instead of a mixture of fungi, since individual fungi interact differently with a given biocide in the coating. The moisture content of the wood substrate during the test was affected by how the fungus was established on the coating. This new test approach shows promise in screening the antifungal efficiency of wood coatings containing preservative substances applied to wood material surfaces. [ABSTRACT FROM AUTHOR]

This comment aims to contribute to agenda-setting for the study of interpersonal violence over the years to come. Interpersonal violence is a high-profile topic not only in the domain of criminology, but also in public health, medicine, and epidemiology, and across the social sciences (sociology; psychology; economics; and political science). However, interdisciplinary integration between the different perspectives is lacking. This comment takes up the question of how scholars and practitioners in the field of violence can work towards greater integration with other perspectives. It outlines five key priorities for the field going forward, which are intended to contribute to a more comprehensive understanding of interpersonal violence. Importantly, the view outlined here arose from a collaboration of researchers from a wide range of academic fields, and as such represents interdisciplinary consensus on the steps required to ensure that the study of interpersonal violence remains an effective and productive research field. [ABSTRACT FROM AUTHOR]

Purpose: Instrumentation of the C1 vertebra requires either mobilization or transection of the C2 nerve root. This study investigates clinical and radiological outcomes and incidences of C2 neuropathic pain after posterior instrumented fusion in the cranio-cervical junction with or without division of the C2 nerve roots. Methods: This retrospective study compared two cohorts of patients who underwent instrumented fusion in the cranio-cervical junction. Fifty patients (22 males and 28 females) were operated with complete resection of C2 nerve root ganglion (Ex group), and fifty-one patients (30 men, 21 women) with C2 nerve roots preservation (No group). Results: The incidence of postoperative C2 neuropathy was eight times lower in the Ex group compared to the No group that was statistical significant, p = 0.039. Surgical time was significantly shorter in the No group (p = 0.001). The fusion rates were very high for both groups, without difference between groups (p = 1.0). Autografting from the iliac crest (p = 0.001) as well as postoperative immobilisation with a hard collar (p < 0.001) were required in fewer patients in the Ex group. Also, patients in the Ex group were mobilised faster after surgery (p = 0.49). Overall, complication rates were similar between groups, but the Ex group demonstrated fewer major medical complications (16% vs 31%). Male sex and iliac bone harvesting demonstrated significantly higher OR for development of postoperative complications (p = 0.023 and p = 0.034 respectively) and postoperative mobilization demonstrated significant higher OR for development of postoperative major complications (p = 0.042). Conclusions: Resection of the C2 nerve root ganglion during posterior instrumented fusion of the cranio-cervical junction is safe and rarely leads to C2 neuropathy. The technique tends to mitigate the odds of developing postoperative complications. [ABSTRACT FROM AUTHOR]

The aim of the creation of this cohort was to investigate patterns of health and health care utilisation before and during the COVID-19 pandemic, overall and in relation to specific diagnoses, among people with intellectual disabilities (ID) compared to the general population. People living in Skåne, the southernmost region of Sweden, on 1st of January 2014 with at least one diagnosis of ID (ICD-10 codes F70-F79) or Down syndrome (DS; Q90), or support and/or services according to the LSS act comprised the ID cohort (n = 14 716). People living in the same family and/or household as a person in the ID cohort constituted the ID family cohort (n = 31 688), and those remaining comprised the general population cohort (gPop; n = 1 226 955). Data has been collected for all three cohorts from several national and regional registers. These include registers for health care (2014–2021), deaths (2014–2021), COVID-19-related health care (vaccinations, intensive care, palliative care, 2020–2021). The prevalence of ID was 1.2%. In the ID cohort, 77.9% had at least one measure of support, 5.8% at least one Q90-diagnosis and 63.8% had at least one F7-diagnosis (26.9% mild (F70), 7.4% moderate (F71), 2.8% severe (F72), 1.4% profound (F73), and 25.4% other/unknown (F78/F79)). Compared to the gPop there were more people in the younger age groups in the ID cohort. At this point, no additional collection of data will be carried out. However, there is a possibility to add data from the registers to include years after 2021 or from additional registers. Future publications will explore relevant research questions and report key findings in relation to health among people with ID. Future results will be used to inform policy and practice on people with ID. [ABSTRACT FROM AUTHOR]

Mental health problems are increasing among children and adolescents. School-based mindfulness interventions are gaining popularity worldwide and may be a way to decrease depression and anxiety symptoms in students. However, before introducing large-scale mindfulness interventions in school settings, more research is needed on feasible, easily applicable practices that are possible to fit in the school schedule. In this controlled intervention study, a total of 1399 students aged 9–16 were included. The 10-week classroom-based mindfulness intervention comprised daily, brief mindfulness sessions led by schoolteachers or via audio files. Symptoms of depression and anxiety were evaluated with Beck scales prior to and after the intervention. In addition to whole group analyses, subgroup analyses on age, sex as well as mode of delivery were performed. ClinicalTrials.gov ID: NCT03327714. No significant differences between the intervention and control group in change of depression or anxiety symptoms after the intervention were detected. However, the subgroup of students who received teacher-led mindfulness sessions (16%) had a significant decrease of depression and anxiety symptoms after 10 weeks compared to those who received the sessions via audio files. Brief mindfulness sessions on daily basis did not have any detectable overall effect on depression and anxiety symptoms among schoolchildren. Our findings do not support an introduction of large-scale mindfulness interventions in schools although the potential influence of mode of delivery needs to be further examined. Clinical trial registration The study was registered at ClinicalTrials.gov (identifier: NCT03327714). [ABSTRACT FROM AUTHOR]

Coherent x-ray imaging and scattering from accelerator based sources such as synchrotrons continue to impact biology, medicine, technology, and materials science. Many synchrotrons around the world are currently undergoing major upgrades to increase their available coherent x-ray flux by approximately two orders of magnitude. The improvement of synchrotrons may enable imaging of materials in operando at the atomic scale which may revolutionize battery and catalysis technologies. Current algorithms used for phase retrieval in coherent x-ray imaging are based on the projection onto sets method. These traditional iterative phase retrieval methods will become more computationally expensive as they push towards atomic resolution and may struggle to converge. Additionally, these methods do not incorporate physical information that may additionally constrain the solution. In this work, we present an algorithm which incorporates molecular dynamics into Bragg coherent diffraction imaging (BCDI). This algorithm, which we call PRAMMol (Phase Retrieval with Atomic Modeling and Molecular Dynamics) combines statistical techniques with molecular dynamics to solve the phase retrieval problem. We present several examples where our algorithm is applied to simulated coherent diffraction from 3D crystals and show convergence to the correct solution at the atomic scale. [ABSTRACT FROM AUTHOR]

Previous reviews have often shown a link between digital media ADHD symptom levels. However, longitudinal studies are needed to find stronger evidence of a causal effect as well as to determine the direction of effects. The aim of the present review (PROSPERO CRD42021262695) was therefore to provide a systematic review of studies meeting the following inclusion criteria: (1) include longitudinal data investigating associations between digital media (i.e., gaming and social media) and later ADHD symptoms or vice versa, (2) be published within the past 10 years (i.e., 2011 until June 2021), (3) be published in a peer-reviewed journal in English, and (4) include children or adolescents (age 0–17 years). After a systematic search in the Web of Science and PsycInfo databases, we included 28 studies, all with adequate or high quality. Results showed support for reciprocal associations between digital media and ADHD symptoms, with associations being more consistent for problematic use of digital media than for screen time. Thus, children with ADHD symptoms appear more vulnerable to developing high or problematic use of digital media (i.e., selection effects), and digital media also have effects on later ADHD symptom levels, either because of specific characteristics of digital media or because of indirect effects on, for example, sleep and social relations (i.e., media effects). However, it should be emphasized that further studies investigating potential moderators and mediators are needed if we are to better understand the complex associations between digital media and ADHD symptom levels. [ABSTRACT FROM AUTHOR]

Clinical decision-making for individuals with 46,XY disorders/differences of sex development (DSD) remains unsettled and controversial. The North American DSD Clinician Survey examines the recommendations of a large group of clinical specialists over the last two decades. Active members of the (Lawson Wilkins) Pediatric Endocrine Society and the Societies for Pediatric Urology were invited to respond to a web-based survey at three different timepoints: 2003–2004 (T1), 2010–2011 (T2), and 2019–2020 (T3). Data from 429 participants in T1, 435 in T2, and 264 in T3 were included in this study. The participants were presented with three XY newborn clinical case scenarios—micropenis, partial androgen insensitivity syndrome, and iatrogenic penile ablation—and asked for clinical management recommendations. The main outcomes assessed included the recommended gender of rearing, surgical decision-maker (parent or patient), timing of genital surgery, and age at which to disclose medical details and surgical history to the patient. For all scenarios, the overwhelming majority recommended rearing as male, including a significant increase across timepoints in those recommending a male gender of rearing for the infant with penile ablation. The proportions recommending female gender of rearing declined significantly across timepoints. In general, most recommended parents (in consultation with the physician) serve as surgical decision-makers, but these proportions declined significantly across timepoints. Recommendations on the timing of surgery varied based on the patient's gender and type of surgery. There has been a shift in recommendations away from the "optimal gender policy" regarding gender of rearing and surgical interventions for patients with XY DSD. [ABSTRACT FROM AUTHOR]

Background and Objectives: Trifluridine/tipiracil, registered for the treatment of patients with metastatic gastric and colorectal cancer, is a substrate and inhibitor for the organic cation transporter 2 (OCT2) and the multidrug and toxin extrusion protein 1 (MATE1), which raises the potential for drug–drug interactions with other OCT2/MATE1 modulators. Therefore, we prospectively examined the effect of an OCT2/MATE1 inhibitor (cimetidine) and substrate (metformin) on the pharmacokinetics of trifluridine. Methods: In this three-phase crossover study, patients with metastatic colorectal or gastric cancer were sequentially treated with trifluridine/tipiracil alone (phase A), trifluridine/tipiracil concomitant with metformin (phase B) and trifluridine/tipiracil concomitant with cimetidine (phase C). The primary endpoint was the relative difference in exposure of trifluridine assessed by the area under the curve from timepoint zero to infinity. A > 30% change in exposure was considered clinically relevant. A p-value of < 0.025 was considered significant because of a Bonferroni correction. Results: Eighteen patients were included in the analysis. Metformin did not significantly alter the exposure to trifluridine (− 12.6%; 97.5% confidence interval − 25.0, 1.8; p = 0.045). Cimetidine did alter the exposure to trifluridine significantly (+ 18.0%; 97.5% confidence interval 4.5, 33.3; p = 0.004), but this increase did not meet our threshold for clinical relevance. Metformin trough concentrations were not influenced by trifluridine/tipiracil. Conclusions: Our result suggests that the OCT2/MATE1 modulators cimetidine and metformin can be co-administered with trifluridine/tipiracil without clinically relevant effects on drug exposure. Clinical Trial Registration: NL8067 (registered 04-10-2019). [ABSTRACT FROM AUTHOR]

Criminology have long celebrated the lone hero researcher. Doing and writing up research in solitude has been the key to academic success and institutional promotions. However, the social sciences in general have increasingly moved towards more collaborative ways of doing research, and co-authorship has become more common. In this study, we summarize and discuss the pros and cons of working in teams when doing qualitative research. Drawing upon our own experiences from Mexico and Norway, we argue for a radical approach to team research and co-authorship, which we describe as team writing. Most importantly, we suggest opening up to include stakeholders and community partners, thus challenging the borders between researchers and those researched. This is arguably particularly important for research done in the academic, geographical and topical periphery of criminology. Team research and writing answers some of the critique of power inequality, representativity and lack of diversity in contemporary academic research. We also believe that team research, and writing, can make criminological research more multifaceted, reflexive, and thus better. [ABSTRACT FROM AUTHOR]

Abstract Subjectivity is a widely explored topic in dementia studies, in both the humanities and the social sciences. Persistent discourses of “a loss of self” in dementia have been challenged by scholars, who argue for the need for continued recognition of the person with dementia and that subjectivity in dementia may be sustained. So far, however, there is a lack of discussion about the significance of gender, and how being recognised as a subject overall is closely intertwined with being recognised as a gendered subject. This article explores how gender matters to the recognition of subjectivity in dementia. But it also explores how dementia as a position of cognitive otherness may impact upon and disrupt gender performativity. The discussion builds on narratives from an interview study on intimacy and sexual relationships among heterosexual couples living with Alzheimer’s disease, as well as the narrative of the Swedish autobiographical novel Minns du? [Do you remember?] (Beckman, 2019), in which the nonbinary transgender narrator Alice seeks to recollect the memories of their partner AnnaBelle, who is living with a memory-related illness. The article shows how reiterations of gender could be significant in sustaining subjectivity for a person with dementia. But it also shows how cultural tropes of persons with dementia as strange(rs), children or animals position them as unintelligible and thus as unrecognisable gendered subjects. The novel, in contrast, provides an alternative form of worldmaking in which intersubjective recognition is not dependent on either cognitive function or binary gender within a heterosexual matrix.

To assess the oncologic efficacy and safety of robot-assisted approach to radical nephroureterectomy (RARNU) in geriatric versus younger patients with upper tract urothelial carcinoma (UTUC). A single-center, retrospective cohort study was conducted from 2009 to 2022 of 145 patients (two cohorts: < 75 and ≥ 75 years old) with non-metastatic UTUC who underwent RARNU. Primary endpoint was UTUC-related recurrence of disease during surveillance (bladder-specific and metastatic). Safety was assessed according to 30-day, modified Clavien–Dindo (CD) classifications (Major: C.D. III–V). Survival estimates were performed using Kaplan–Meier method. There were 89 patients < 75 years (median 65 years) and 56 patients ≥ 75 years (median 81 years). Comparing the young versus geriatric cohorts: median follow-up 38 vs 24 months (p = 0.03, respectively) with similar 3-year bladder-specific recurrence survival (60% vs 67%, HR 0.70, 95% CI [0.35, 1.40], p = 0.31) and metastasis-free survival (79% vs 70%, HR 0.71, 95% CI [0.30, 1.70], p = 0.44). Expectedly, the younger cohort had a significant deviation in overall survival compared to the geriatric cohort at 1-year (89% vs 76%) and 3-years (72% vs 41%; HR 3.29, 95% CI [1.88, 5.78], p < 0.01). The 30-day major (1% vs 0) and minor complications (8% vs 14%, p = 0.87). Limitations include retrospective study design of a high-volume, single-surgeon experience. Compared to younger patients with UTUC, geriatric patients undergoing RARNU have similar oncologic outcomes at intermediate-term follow-up with no increased risk of 30-day perioperative complications. Thus, age alone should not be used to disqualify patients from definitive surgical management of UTUC with RARNU. [ABSTRACT FROM AUTHOR]

Background: The International Prostate Symptom Score (IPSS) is a patient-reported measurement to assess the lower urinary tract symptoms of bladder outlet obstruction. Bladder outlet obstruction induces molecular and morphological alterations in the urothelium, suburothelium, detrusor smooth muscle cells, detrusor extracellular matrix, and nerves. We sought to analyze MRI-based radiomics features of the urinary bladder wall and their association with IPSS. Method: In this retrospective study, 87 patients who had pelvic MRI scans were identified. A biomarker discovery approach based on the optimal biomarker (OBM) method was used to extract features of the bladder wall from MR images, including morphological, intensity-based, and texture-based features, along with clinical variables. Mathematical models were created using subsets of features and evaluated based on their ability to discriminate between low and moderate-to-severe IPSS (less than 8 vs. equal to or greater than 8). Results: Of the 7,666 features per patient, four highest-ranking optimal features were derived (all texture-based features), which provided a classification accuracy of 0.80 with a sensitivity, specificity, and area under the receiver operating characteristic curve of 0.81, 0.81, and 0.87, respectively. Conclusion: A highly independent set of urinary bladder wall features derived from MRI scans were able to discriminate between patients with low vs. moderate-to-severe IPSS with accuracy of 80%. Such differences in MRI-based properties of the bladder wall in patients with varying IPSS's might reflect differences in underlying molecular and morphological alterations that occur in the setting of chronic bladder outlet obstruction. [ABSTRACT FROM AUTHOR]

Transition to the postanesthesia care unit (PACU) requires timely order placement by anesthesia providers. Computerized ordering enables automated order reminder systems, but their value is not fully understood. We performed a single-center, retrospective cohort study to estimate the association between automated PACU order reminders and primary outcomes (1) on-time order placement and (2) the degree of delay in placement. As a secondary post-hoc analysis, we studied the association between late order placement and PACU outcomes. We included patients with a qualifying postprocedure order from January 1, 2019, to May 31, 2023. We excluded cases transferred directly to the ICU, whose anesthesia provider was involved in the pilot testing of the reminder system, or those with missing covariate data. Order reminder system usage was defined by the primary attending anesthesiologist's receipt of a push notification reminder on the day of surgery. We estimated the association between reminder system usage and timely order placement using a logistic regression. For patients with late orders, we performed a survival analysis of order placement. The significance level was 0.05. Patient (e.g., age, race), procedural (e.g., anesthesia duration), and provider-based (e.g., ordering privileges) variables were used as covariates within the analyses. Reminders were associated with 51% increased odds of order placement prior to PACU admission (Odds Ratio: 1.51; 95% Confidence Interval: 1.43, 1.58; p ≤ 0.001), reducing the incidence of late PACU orders from 17.5% to 12.6% (p ≤ 0.001). In patients with late orders, the reminders were associated with 10% quicker placement (Hazard Ratio: 1.10; 95% CI 1.05, 1.15; p < 0.001). On-time order placement was associated with decreased PACU duration (p < 0.001), decreased odds of peak PACU pain score (p < 0.001), and decreased odds of multiple administration of antiemetics (p = 0.02). An order reminder system was associated with an increase in order placement prior to PACU arrival and a reduction in delay in order placement after arrival. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: The aim of this study was to explore home rehabilitation therapists' experiences of supporting physical exercise after acute hospitalization, including exercise programs initiated during hospital stay. Findings: The participants experienced that they were striving for individualized support to physical exercise, although limited resources and a fragmented home care risk to direct support away from those who need it the most. Message: Transitional care interventions need to be individualized, support motivation for exercise during hospitalization, and be adapted to the patient's situation at home, as well as involve relevant stakeholder in the design and implementation. Purpose: After hospitalization, older persons may face a decline in physical function and daily independence. In-hospital exercise interventions can mitigate this decline, and continued support from primary healthcare post-discharge may enhance sustainability. This study aimed to explore home rehabilitation therapists' experiences of supporting physical exercise after acute hospitalization, including exercise programs initiated during hospital stay. Methods: This qualitative study was conducted alongside a randomized-controlled trial to investigate prerequisites for a transitional care intervention. Twelve interviews were conducted with physiotherapists, occupational therapists, and managers across seven rehabilitation therapy services in Stockholm, Sweden. Data were analyzed using reflexive thematic analysis. Results: The analysis generated the theme Striving for individualized support for physical exercise, although limited resources and a fragmented home care risk to direct support away from those who need it the most. It was based on four subthemes: The starting point is always the patient's current needs, goals, and prerequisites, Continuing the exercise initiated during hospitalization by adapting it to the patient's situation at home, Work premises not tailored to patients with complex care needs, and A home care organization that lacks coordination and unified purpose. Conclusions: Interventions supporting older persons to physical exercise after acute hospitalization need to be tailored to the individual, support motivation, and be adapted to the patient's home situation. Challenges may arise when care recourses lack alignment with the patients' needs, and when the collaboration among care providers is limited. The findings contribute valuable insights for future studies incorporating transitional care interventions in similar context. [ABSTRACT FROM AUTHOR]

Of the medals awarded during the Winter Olympics Games, most are awarded for sports involving cross-country (XC) skiing. The Double Poling (DP) technique, which is one of the sub-techniques used most frequently in XC skiing, has not yet been studied using simulations of the ski–snow contact mechanics. This work introduces a novel method for analysing how changes in the distribution of pressure on the sole of the foot (Plantar Pressure Distribution or PPD) during the DP motion affect the contact between the ski and the snow. The PPD recorded as the athlete performed DP, along with an Artificial Neural Network trained to predict the geometry of the ski (ski-camber profile), were used as input data for a solver based on the boundary element method, which models the interaction between the ski and the snow. This solver provides insights into how the area of contact and the distribution of pressure on the ski-snow interface change over time. The results reveal that variations in PPD, the type of ski, and the stiffness of the snow all have a significant impact on the contact between the ski and the snow. This information can be used to improve the Double Poling technique and make better choices of skis for specific snow conditions, ultimately leading to improved performance. [ABSTRACT FROM AUTHOR]

Several aspects of clinical management of 46,XX congenital adrenal hyperplasia (CAH) remain unsettled and controversial. The North American Disorders/Differences of Sex Development (DSD) Clinician Survey investigated changes, over the last two decades, in clinical recommendations by specialists involved in the management of newborns with DSD. Members of the (Lawson Wilkins) Pediatric Endocrine Society and the Societies for Pediatric Urology participated in a web-based survey at three timepoints: 2003–2004 (T1, n = 432), 2010–2011 (T2, n = 441), and 2020 (T3, n = 272). Participants were presented with two clinical case scenarios—newborns with 46,XX CAH and either mild-to-moderate or severe genital masculinization—and asked for clinical recommendations. Across timepoints, most participants recommended rearing the newborn as a girl, that parents (in consultation with physicians) should make surgical decisions, performing early genitoplasty, and disclosing surgical history at younger ages. Several trends were identified: a small, but significant shift toward recommending a gender other than girl; recommending that adolescent patients serve as the genital surgery decision maker; performing genital surgery at later ages; and disclosing surgical details at younger ages. This is the first study assessing physician recommendations across two decades. Despite variability in the recommendations, most experts followed CAH clinical practice guidelines. The observation that some of the emerging trends do not align with expert opinion or empirical evidence should serve as both a cautionary note and a call for prospective studies examining patient outcomes associated with these changes. [ABSTRACT FROM AUTHOR]

Purpose: Vascular anomalies are classified as either vascular tumors or vascular malformations. Vascular malformations can be difficult to diagnose and treat in the pediatric population and can masquerade as malignant processes. Understanding the genetics behind vascular malformations can lead to identification of specific mutations which can be treated with targeted immunotherapy. Methods: Our case presents a pediatric patient with progressively enlarging vascular malformation despite multiple surgical resections and systemic medical treatments who underwent genetic evaluation and was found to have PIK3CA mutation. Results: After identification of PIK3CA mutation, our patient was successfully treated with the p110ɑ-specific inhibitor, alpelisib, with both shrinkage of malformation on follow-up imaging as well as gains in her developmental milestones. Conclusion: Progressive vascular malformations in the pediatric population can be hard to diagnose and treat and are thought to arise from somatic mutations. Our case highlights a patient with progressive malformation despite multiple surgical resections who was successfully treated with targeted immunotherapy after proper identification of genetic mutation. [ABSTRACT FROM AUTHOR]

Introduction: Allergies and other immune-mediated diseases are thought to result from incomplete maturation of the immune system early in life. We previously showed that infants' metabolites at birth were associated with immune cell subtypes during infancy. The placenta supplies the fetus with nutrients, but may also provide immune maturation signals. Objectives: To examine the relationship between metabolites in placental villous tissue and immune maturation during the first year of life and infant and maternal characteristics (gestational length, birth weight, sex, parity, maternal age, and BMI). Methods: Untargeted metabolomics was measured using Liquid Chromatography-Mass Spectrometry. Subpopulations of T and B cells were measured using flow cytometry at birth, 48 h, one, four, and 12 months. Random forest analysis was used to link the metabolomics data with the T and B cell sub populations as well as infant and maternal characteristics. Results: Modest associations (Q2 = 0.2–0.3) were found between the placental metabolome and kappa-deleting recombination excision circles (KREC) at birth and naïve B cells and memory T cells at 12 months. Weak associations were observed between the placental metabolome and sex and parity. Still, most metabolite features of interest were of low intensity compared to associations previously found in cord blood, suggesting that underlying metabolites were not of placental origin. Conclusion: Our results indicate that metabolomic measurements of the placenta may not effectively recognize metabolites important for immune maturation. [ABSTRACT FROM AUTHOR]

Abstract Evidence suggests that novel enzyme functions evolved from low‐level promiscuous activities in ancestral enzymes. Yet, the evolutionary dynamics and physiological mechanisms of how such side activities contribute to systems‐level adaptations are not well characterized. Furthermore, it remains untested whether knowledge of an organism's promiscuous reaction set, or underground metabolism, can aid in forecasting the genetic basis of metabolic adaptations. Here, we employ a computational model of underground metabolism and laboratory evolution experiments to examine the role of enzyme promiscuity in the acquisition and optimization of growth on predicted non‐native substrates in Escherichia coli K‐12 MG1655. After as few as approximately 20 generations, evolved populations repeatedly acquired the capacity to grow on five predicted non‐native substrates—D‐lyxose, D‐2‐deoxyribose, D‐arabinose, m‐tartrate, and monomethyl succinate. Altered promiscuous activities were shown to be directly involved in establishing high‐efficiency pathways. Structural mutations shifted enzyme substrate turnover rates toward the new substrate while retaining a preference for the primary substrate. Finally, genes underlying the phenotypic innovations were accurately predicted by genome‐scale model simulations of metabolism with enzyme promiscuity.

Purpose: To calculate the frequency of infection and acute urinary retention (AUR) following transperineal (TP) prostate biopsy at a single high-volume academic institution and determine risk factors for developing these post-biopsy conditions. Methods: Men undergoing TP prostate biopsy from 2012 to 2022 at our institution were retrospectively identified and chart reviewed. TP biopsies were performed with TR ultrasound (TRUS) guidance with anesthesia using a brachytherapy grid template. TRUS volumes were recorded during the procedure, and magnetic resonance imaging (MRI) volumes were calculated using the ellipsoid formula. When available, MRI volume was used for all analysis, and when absent, TRUS volume was used. AUR was defined as requiring urinary catheter placement within 72 h post-biopsy for inability to urinate. Univariable analysis was performed and variables with p < 0.1 and/or established clinical relevance were included in a backward binary logistic regression to produce an optimized model that fit the data without collinearity between variables. Results: A total of 767 TP biopsies were completed in the study window. The frequency of infection was 1.83% (N = 14/767). The total frequency of AUR was 5.48% (N = 42/767). On multivariable regression, patients who went into AUR were five times as likely to develop infection (p = 0.020). Patients with infection post-TP biopsy were four times as likely to develop AUR (p = 0.047) and with prostates > 61.21 cc were three times as likely (p = 0.019). Conclusion: According to our model, AUR is the greatest risk factor for infection post-TP biopsy. With regard to AUR risks, infection post-biopsy and prostate size > 61.21 cc are the greatest risk factors. [ABSTRACT FROM AUTHOR]

The nature of snow and the ever-changing environment makes measuring friction on snow and ice challenging. Additionally, due to the low friction involved, the equipment used must exhibit high sensitivity. Previous investigations of ski–snow friction have ranged from small-scale model experiments performed in the laboratory to experiments with full-sized skis outdoors. However, few have been conducted under conditions similar to those encountered during actual skiing. Here, we present a novel sled tribometer which provides highly reproducible coefficient of friction (COF) values for full-sized skis gliding at relevant speeds (approximately 5.9 m/s) in a controlled indoor environment. The relative standard deviation (RSD) of the COF is as low as 0.5%. The continuous recording of velocity allows for innovative investigations into COF variations when skis are permitted to free-glide in a natural setting. Different methods of analysing the results are presented which shows that the precision is not a single number, but a function of the range of velocities over which the average COF is calculated. [ABSTRACT FROM AUTHOR]

Our study is motivated by radiation therapy design for cancer treatment. We consider large-scale problems with stochastic order constraints. We establish a general result about the form of the deepest cuts associated with events of positive probability which are used in the numerical approximation of the functional constraints. An efficient method using the deepest cuts is proposed for the numerical solution of problems with second-order dominance constraints and increasing convex order constraints. We the propose a new methodology for the radiation-therapy design for cancer treatment. We introduce a risk-averse optimization problem with two types of stochastic order relations and with coherent measures of risk and consider the effect of the risk models in three versions of the problem formulation. Additionally, we propose a method that creates flexible (floating) benchmark distributions when benchmark distributions are not given apriori or when the provided distributions lead to infeasibility. We devise a numerical method using floating benchmarks for solving the proposed risk-averse optimization models for radiation therapy design. The models and methods are verified by using clinical data confirming the viability of the proposed methodology and its efficiency. [ABSTRACT FROM AUTHOR]

Use of big data in the nonprofit sector is on the rise as a part of a trend toward "data-driven" management. While big data has its critics, few have addressed fundamental ontological and epistemological issues big data presents for the nonprofit sector. In this article, we address some of these issues including most prominently the notion that big data are value neutral and divorced from context. Drawing on data feminism, an intersectional feminist framework focusing on critically interrogating our experience with data and data-driven technologies, we examine the power differentials inherent in the construction of big data and challenge the claims, priorities, and inequities it produces specifically for nonprofit work. We conclude the article with a call for nonprofit scholars and practitioners to employ a data feminist framework to harness the power of big (and small) data for justice, equity, and co-liberation through nonprofit work. [ABSTRACT FROM AUTHOR]

The use of magnetic resonance imaging (MRI) in the evaluation of the central extracranial nervous system, namely the brachial and lumbosacral plexuses, is well established and has been performed for many years. Only recently after numerous advances in MRI, has image quality been sufficient to properly visualize small structures, such as nerves in the extremities. Despite the advances, peripheral MR Neurography remains a complex and difficult examination to perform, especially in the pediatric patient population, in which the risk for motion artifact and compliance is always of concern. Thus, technical aspects of the MR imaging protocol must be flexible but robust, to balance image quality with scan time, in a patient population of varying sizes. An additional important step for reliably performing a successful MR Neurography examination is the non-technical pre-imaging preparation, which includes patient/family education and open communication with referring teams. This paper will discuss in detail the individual technical and non-technical/operational aspects of peripheral MR Neurography, to help guide in building a successful program in the pediatric population. [ABSTRACT FROM AUTHOR]

Purpose: To describe injury incidence, time trends in injury incidence, and injury characteristics among Swedish Olympic athletes over 22 years based on insurance data, as a first step to inform injury preventive measures among Olympic athletes. Methods: The cohort comprised 762 elite athletes (54% males; age 26.5 ± 5.9 years) in 38 sports in the Swedish Olympic Committee support program 'Top and Talent' between 1999 and 2020, with total 3427 athlete-years included. Acute and gradual onset injuries were reported to the insurance registry by the athletes' medical staff. Results: A total of 1635 injuries in 468 athletes were registered. The overall injury incidence was 47.7 injuries/100 athlete-years (one injury per athlete every second year). An increasing trend in injury incidence was observed in the first decade 2001 to 2010 (annual change 6.0%, 95% CI 3.3–8.8%), while in the second decade 2011 to 2020 no change was evident (0.4%, 95% CI − 1.9 to 2.7%). Gymnastics, tennis, and athletics had the highest incidence (100.0, 99.3, and 93.4 injuries/100 athlete-years, respectively). Among sport categories, mixed and power sports had the highest incidence (72.8 and 69.5 injuries/100 athlete-years, respectively). Higher incidences were seen in the younger age groups (≤ 25 years) in mixed and skill sports. The injury incidence was comparable between male and female athletes, and summer and winter sports. Most injuries occurred in the lower limb, and specifically the knee (24%), foot/ankle (15%) and spine/pelvis (13%). Conclusion: The results on injury patterns in different sports and age groups may guide preventive focus for health and performance teams working with Olympic athletes. Level of evidence: II. [ABSTRACT FROM AUTHOR]

In line with recent trends in sociology of migration, the paper presents major research findings on Swedish immigrant organizations (SIOs) and their labor market integration activities. Analyses of engagement in these activities are particularly important as Sweden wrestles with significant problems of labor market marginalization, particularly among non-European migrants. Drawing on official data and interviews, we find surprisingly low incidence in direct labor market support but quite active indirect support. Our regression model shows significant correlation between region of origin and labor market activities, and further analyses using regional typologies indicate that SIOs' activities are partly driven by members' different modes of incorporation and relative integration, where Middle-Eastern SIOs stand out as particularly active. Our findings further indicate potential for scale-up of SIO-assistance in the Swedish Government's efforts towards increased immigrant labor market integration. [ABSTRACT FROM AUTHOR]

Abstract In Arabidopsis, lateral roots originate from pericycle cells deep within the primary root. New lateral root primordia (LRP) have to emerge through several overlaying tissues. Here, we report that auxin produced in new LRP is transported towards the outer tissues where it triggers cell separation by inducing both the auxin influx carrier LAX3 and cell‐wall enzymes. LAX3 is expressed in just two cell files overlaying new LRP. To understand how this striking pattern of LAX3 expression is regulated, we developed a mathematical model that captures the network regulating its expression and auxin transport within realistic three‐dimensional cell and tissue geometries. Our model revealed that, for the LAX3 spatial expression to be robust to natural variations in root tissue geometry, an efflux carrier is required—later identified to be PIN3. To prevent LAX3 from being transiently expressed in multiple cell files, PIN3 and LAX3 must be induced consecutively, which we later demonstrated to be the case. Our study exemplifies how mathematical models can be used to direct experiments to elucidate complex developmental processes.

Patients with MYC rearranged (MYC-R) diffuse large B-cell lymphoma (DLBCL) have a poor prognosis. Previously, we demonstrated in a single-arm phase II trial (HOVON-130) that addition of lenalidomide to R-CHOP (R2CHOP) is well-tolerated and yields similar complete metabolic remission rates as more intensive chemotherapy regimens in literature. In parallel with this single-arm interventional trial, a prospective observational screening cohort (HOVON-900) was open in which we identified all newly diagnosed MYC-R DLBCL patients in the Netherlands. Eligible patients from the observational cohort that were not included in the interventional trial served as control group in the present risk-adjusted comparison. R2CHOP treated patients from the interventional trial (n = 77) were younger than patients in the R-CHOP control cohort (n = 56) (median age 63 versus 70 years, p = 0.018) and they were more likely to have a lower WHO performance score (p = 0.013). We adjusted for differences at baseline using 1:1 matching, multivariable analysis, and weighting using the propensity score to reduce treatment-selection bias. These analyses consistently showed improved outcome after R2CHOP with HRs of 0.53, 0.51, and 0.59, respectively, for OS, and 0.53, 0.59, and 0.60 for PFS. Thus, this non-randomized risk-adjusted comparison supports R2CHOP as an additional treatment option for MYC-R DLBCL patients. [ABSTRACT FROM AUTHOR]

Photodiodes are ubiquitous in industry and consumer electronics. Constantly emerging new applications for photodiodes demand different mechanical and optoelectronic properties from those provided by conventional inorganic-based semiconductor devices. This has stimulated considerable interest in the use of organic semiconductors, which provide a vast palette of available optoelectronic properties, can be incorporated into flexible form factor geometries, and promise low-cost, low-embodied energy manufacturing from earth-abundant materials. The sensitivity of a photodiode depends critically on the dark current. Organic photodiodes (OPDs), however, are characterized by a much higher dark current than expected for thermally excited radiative transitions. Here we show that the dark saturation current in OPDs is fundamentally limited by mid-gap trap states. This new insight is generated by the universal trend observed for the dark saturation current of a large set of OPDs and further substantiated by sensitive external-quantum-efficiency- and temperature-dependent current measurements. Based on this insight, an upper limit for the specific detectivity is established. A detailed understanding of the origins of noise in any detector is fundamental to defining performance limitations and thus is critical to materials and device selection, and design and optimization for all applications. Our work establishes these important principles for OPDs. Researchers demonstrate that the dark saturation current in organic photodiodes is fundamentally limited by mid-gap trap states. This leads to an upper limit for specific detectivity. [ABSTRACT FROM AUTHOR]

Resin-injection pultrusion (RIP) processes utilise a high resin pressure to ensure fast resin impregnation. When the resin is injected, the fibre material may compress and deform, and since the material flow is closely related to the fibre volume fraction, it is important to understand and predict the effects of flow-induced fibre compaction. In this paper, we derive the governing equations and present a novel numerical framework for analyses of flow-induced fibre compaction in RIP. Based on temperature measurements and material characterisation of the fibre reinforcement (compaction behaviour and permeability), we analyse the effects of flow-induced fibre compaction on non-isothermal material flow in an industrial RIP process. For the case study, we found that fibre compaction reduced flow resistance and facilitated resin impregnation as the fibre volume fraction was locally reduced near the inlet. This meant that the flow front was moved upstream (≈ 3 cm) and the exit pressure was increased from 4.8 to 6.2 bar. Also, the fibre volume fraction was increased in the centre of the profile, whereby impregnation took place over a longer distance as the flow front had a deeper apex. Finally, we showed that the compaction response of the fibre material remained largely unaffected by the magnitude of the injection pressure, which was not the case for the fibre volume fraction, pulling speed, and resin viscosity. This work and the presented methodology are important contributions towards improving the understanding of the material flow in RIP, in particular, for larger profiles with a lower fibre volume fraction. [ABSTRACT FROM AUTHOR]

The article "Country Comfort? Risk Factors for Unplanned Healthcare Visits in Rural America in Children with IBD" published in Digestive Diseases & Sciences explores the factors contributing to unplanned healthcare visits in children with inflammatory bowel disease (IBD) in rural areas of the Southeastern United States. The study reveals that higher disease severity, public insurance, and female gender are associated with increased healthcare utilization. The findings suggest the need for further research to identify targets for quality improvement and process enhancement in healthcare for children with IBD in rural regions. [Extracted from the article]

The biosphere represents the global sum of all ecosystems. According to a prominent view in environmental ethics, ecocentrism, these ecosystems matter for their own sake, and not only because they contribute to human ends. As such, some ecocentrists are critical of the modern industrial civilization, and a few even argue that an irreversible collapse of the modern industrial civilization would be a good thing. However, taking a longer view and considering the eventual destruction of the biosphere by astronomical processes, we argue that humans, a species with considerable technological know-how and industrial capacity could intervene to extend the lifespan of Earth's biosphere, perhaps by several billion years. We argue that human civilization, despite its flaws and harmful impacts on many ecosystems, is the biosphere's best hope of avoiding premature destruction. We argue that proponents of ecocentrism, even those who wholly disregard anthropocentric values, have a strong moral reason preserve the modern industrial civilization, for as long as needed to ensure biosphere survival. [ABSTRACT FROM AUTHOR]

Mathematical models are essential for the development of schedules for the air-circulation drying of timber in Swedish sawmills, but earlier models have been shown to be conservative leading to longer drying times than necessary. In the current study, macroscopic (macro) X-ray computed tomography (CT) has been used in both the development and validation of a finite element (FE) model, to enable the macro-CT aided FE modelling of the nonlinear transient moisture flow in wood. The model uses more advanced theory than has previously been used in Swedish sawmills, by incorporating a surface emission coefficient to simulate the surface resistance to moisture flow. A single piece of Norway spruce [Picea abies (L.) Karst.] timber was subjected to that part of a traditional kiln-drying schedule, which is associated with diffusion-driven moisture transport. The incorporation of macro-CT data into the FE model resulted in a more realistic representation of the board's geometry, the initial moisture state, and the definition of material parameters. It also led to a better simulation of flow speed and moisture gradient, especially the asymmetric MC development within the cross section throughout the drying process. [ABSTRACT FROM AUTHOR]

Current single-cell RNA sequencing (scRNA-seq) methods with high cellular throughputs sacrifice full-transcript coverage and often sensitivity. Here we describe Smart-seq3xpress, which miniaturizes and streamlines the Smart-seq3 protocol to substantially reduce reagent use and increase cellular throughput. Smart-seq3xpress analysis of peripheral blood mononuclear cells resulted in a granular atlas complete with common and rare cell types. Compared with droplet-based single-cell RNA sequencing that sequences RNA ends, the additional full-transcript coverage revealed cell-type-associated isoform variation. Smart-seq3xpress enables single-cell RNA sequencing from full transcripts at high throughput. [ABSTRACT FROM AUTHOR]

A theoretical and empirical association between lucid dreaming and mindfulness, as well as lucid dreaming and nightmares has previously been observed; however, the relationship between nightmares and mindfulness has received surprisingly little attention. Here, we present the findings of two studies exploring the relation of nightmare frequency and distress with two components of mindfulness, termed presence and acceptance, as well as lucid dreaming. Study 1 (N = 338) consisted of a low percentage of frequent lucid dreamers whereas Study 2 (N = 187) consisted primarily of frequent lucid dreamers that used lucid dream induction training techniques and meditation. Across studies, nightmare-related variables showed a more robust association with mindful acceptance as opposed to mindful presence. Moreover, individuals with high levels of meditation expertise and practice of lucid dreaming induction techniques reported lower nightmare frequency. Finally, in Study 2, which consisted of frequent lucid dreamers, a positive correlation between lucid dreaming frequency and mindfulness was apparent. The present findings support the notion that wakeful mindfulness is associated with the quality of dreams and extend previous research by suggesting a disentangled role of the two facets of mindfulness in dream variation. This association remains open for experimental manipulation, the result of which could have clinical implications. [ABSTRACT FROM AUTHOR]

Silicon (Si) is one of the most abundant elements on Earth, and it is the most widely used semiconductor. Despite extensive study, some properties of Si, such as its behaviour under dynamic compression, remain elusive. A detailed understanding of Si deformation is crucial for various fields, ranging from planetary science to materials design. Simulations suggest that in Si the shear stress generated during shock compression is released via a high-pressure phase transition, challenging the classical picture of relaxation via defect-mediated plasticity. However, direct evidence supporting either deformation mechanism remains elusive. Here, we use sub-picosecond, highly-monochromatic x-ray diffraction to study (100)-oriented single-crystal Si under laser-driven shock compression. We provide the first unambiguous, time-resolved picture of Si deformation at ultra-high strain rates, demonstrating the predicted shear release via phase transition. Our results resolve the longstanding controversy on silicon deformation and provide direct proof of strain rate-dependent deformation mechanisms in a non-metallic system. Understanding the how silicon deforms under pressure is important for several fields, including planetary science and materials design. Laser-driven shock compression experiments now confirm that shear stress generated during compression is released via a high-pressure phase transition. [ABSTRACT FROM AUTHOR]

Here we propose a detailed protocol to enable an accelerated inverse design of acoustic coatings for underwater sound attenuation application by coupling Machine Learning and an optimization algorithm with Finite Element Models (FEM). The FEMs were developed to obtain the realistic performance of the polyurethane (PU) acoustic coatings with embedded cylindrical voids. The frequency dependent viscoelasticity of PU matrix is considered in FEM models to substantiate the impact on absorption peak associated with the embedded cylinders at low frequencies. This has been often ignored in previous studies of underwater acoustic coatings, where usually a constant frequency-independent complex modulus was used for the polymer matrix. The key highlight of the proposed optimization framework for the inverse design lies in its potential to tackle the computational hurdles of the FEM when calculating the true objective function. This is done by replacing the FEM with an efficiently computable surrogate model developed through a Deep Neural Network. This enhances the speed of predicting the absorption coefficient by a factor of 4.5 × 10 3 compared to FEM model and is capable of rapidly providing a well-performing, sub-optimal solution in an efficient way. A significant, broadband, low-frequency attenuation is achieved by optimally configuring the layers of cylindrical voids. This is accomplished by accommodating attenuation mechanisms, including Fabry–P e ´ rot resonance and Bragg scattering of the layers of voids. Furthermore, the proposed protocol enables the inverse and targeted design of underwater acoustic coatings through accelerating the exploration of the vast design space compared to time-consuming and resource-intensive conventional trial-and-error forward approaches. [ABSTRACT FROM AUTHOR]