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Abstract Background Cognitive impairment (CI) increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2–3 times more than cognitively healthy older adults and 60–80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community. Methods We conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings. Results Five hundred nine community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [− 1.10, − 0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [− 0.94, − 0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls. Conclusion The effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.

Abstract Background Cognitive impairment (CI) is a risk factor for falls due to environmental or living settings, balance, gait and vision impairments, as well as medications. While previous systematic reviews have focused on the effectiveness of fall prevention programs in adults with cognitive impairment, very limited information is available on their implementation. This review examines what aspects of fall prevention interventions for community-dwelling adults with CI have been reported using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to support successful implementation. Methods We examined the included studies from our systematic review, which searched 7 databases for primary and secondary fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations and extracted data for study characteristics and the 5 dimensions (62 criteria) of the RE-AIM framework. Results Twelve randomized or clinical controlled trials (RCTs/CCTs) consisting of 8 exercise interventions, 3 multifactorial interventions, and 1 medication treatment were included in the review. Only 4 of 62 criteria were reported by all 12 included studies and 29 criteria were not reported by any of the studies. Five of the included studies reported on 20 or more of the 62 possible RE-AIM criteria and 3 of these studies self-identified as “feasibility” studies. While Reach was the best-reported construct by the included studies, followed by Effectiveness and Implementation, the criteria within the Adoption and Maintenance constructs were rarely mentioned by these studies. In general, there was also wide variation in how each of the criteria were reported on by study authors. Conclusion Based on the reporting of RE-AIM components in this review, we are unable to make connections to successful intervention components and thus practice-based recommendations for fall prevention in those with CI. The lack of detail regarding implementation approaches greatly limits the interpretation and comparisons across studies to fully inform future research efforts.

In recent decades, rapid ice shelf disintegration along the Antarctic Peninsula has had a global impact through enhancing outlet glacier flow and hence sea level rise and the freshening of Antarctic Bottom Water. Ice shelf thinning due to basal melting results from the circulation of relatively warm water in the underlying ocean cavity. However, the effect of sub-shelf circulation on future ice shelf stability cannot be predicted accurately with computer simulations if the geometry of the ice shelf cavity is unknown. To address this deficit for Larsen C Ice Shelf, West Antarctica, we integrate new water column thickness measurements from recent seismic campaigns with existing observations. We present these new data here along with an updated bathymetry grid of the ocean cavity. Key findings include a relatively deep seabed to the southeast of the Kenyon Peninsula, along the grounding line and around the key ice shelf pinning-point of Bawden Ice Rise. In addition, we can confirm that the cavity's southern trough stretches from Mobiloil Inlet to the open ocean. These areas of deep seabed will influence ocean circulation and tidal mixing and will therefore affect the basal-melt distribution. These results will help constrain models of ice shelf cavity circulation with the aim of improving our understanding of sub-shelf processes and their potential influence on ice shelf stability. The datasets are comprised of all the new point measurements of seabed depth. We present the new depth measurements here, as well as a compilation of previously published measurements. To demonstrate the improvements to the sub-shelf bathymetry map that these new data provide we include a gridded data product in the Supplement of this paper, derived using the additional measurements of both offshore seabed depth and the thickness of grounded ice. The underlying seismic datasets that were used to determine bed depth and ice thickness are available at https://doi.org/10.5285/315740B1-A7B9-4CF0-9521-86F046E33E9A (Brisbourne et al., 2019), https://doi.org/10.5285/5D63777D-B375-4791-918F-9A5527093298 (Booth, 2019), https://doi.org/10.5285/FFF8AFEE-4978-495E-9210-120872983A8D (Kulessa and Bevan, 2019) and https://doi.org/10.5285/147BAF64-B9AF-4A97-8091-26AEC0D3C0BB (Booth et al., 2019).

Abstract Clinical risk scores that predict outcomes in patients with atrial fibrillation (AF) have modest predictive value. Machine learning (ML) may achieve greater results when predicting adverse outcomes in patients with recently diagnosed AF. Several ML models were tested and compared with current clinical risk scores on a cohort of 26,183 patients (mean age 70.13 (standard deviation 10.13); 44.8% female) with non-valvular AF. Inputted into the ML models were 23 demographic variables alongside comorbidities and current treatments. For one-year stroke prediction, ML achieved an area under the curve (AUC) of 0.653 (95% confidence interval 0.576–0.730), compared to the CHADS2 and CHA2DS2-VASc scores performance of 0.587 (95% CI 0.559–0.615) and 0.535 (95% CI 0.521–0.550), respectively. Using ML for one-year major bleed prediction increased the AUC from 0.537 (95% CI 0.518–0.557) generated by the HAS-BLED score to 0.677 (95% CI 0.619–0.724). ML was able to predict one-year and three-year all-cause mortality with an AUC of 0.734 (95% CI 0.696–0.771) and 0.742 (95% CI 0.718–0.766). In this study a significant improvement in performance was observed when transitioning from clinical risk scores to machine learning-based approaches across all applications tested. Obtaining precise prediction tools is desirable for increased interventions to reduce event rates. Trial Registry https://www.clinicaltrials.gov ; Unique identifier: NCT01468701, NCT01671007, NCT01937377.

Abstract Background Working alongside patients and the public to shape and engage with research, Patient and Public Involvement and Engagement (PPIE), facilitates more impactful research outcomes. The UK Standards for Public Involvement provides a framework for conducting PPIE; however, they do not refer directly to ethical conduct. Research ethics involve the moral principles that govern researchers’ actions, and securing ethical approval from a research ethics committee is necessary before starting a study. Nonetheless, in the UK, ethical approval is not needed for PPIE activities. Main text By its very nature, PPIE requires interaction with patients and public about their lived/living experience of often sensitive and emotional topics. We need to consider ethical principles of PPIE, and potential for harm to those involved. The authors call for ethics guidance to be included in the UK Standards for Public Involvement and discuss this with regards to (a) emotional risk (b) physical risk (c) confidentiality and personal data (d) support versus paternalism (e) marginalisation and (f) building and maintaining healthy relationships. Conclusion The argument presented here has been informed by the authors’ own experiences in topic areas ranging from transplantation, respiratory disease and health inequalities to women living with domestic abuse, and suggests that although requiring ethical approval for PPIE would be a step too far, and stifle research progress, PPIE needs to be conducted with an ‘ethical anchor’ to facilitate ethical practice and mitigate risk.

The area of leaves in the plant canopy, measured as leaf area index (LAI), modulates key land–atmosphere interactions, including the exchange of energy, moisture, carbon dioxide (CO2), and other trace gases and aerosols, and is therefore an essential variable in predicting terrestrial carbon, water, and energy fluxes. Here our goal is to characterize the LAI projections from the latest generation of earth system models (ESMs) for the Representative Concentration Pathway (RCP) 8.5 and RCP4.5 scenarios. On average, the models project increases in LAI in both RCP8.5 and RCP4.5 over most of the globe, but also show decreases in some parts of the tropics. Because of projected increases in variability, there are also more frequent periods of low LAI across broad regions of the tropics. Projections of LAI changes varied greatly among models: some models project very modest changes, while others project large changes, usually increases. Modeled LAI typically increases with modeled warming in the high latitudes, but often decreases with increasing local warming in the tropics. The models with the most skill in simulating current LAI in the tropics relative to satellite observations tend to project smaller increases in LAI in the tropics in the future compared to the average of all the models. Using LAI projections to identify regions that may be vulnerable to climate change presents a slightly different picture than using precipitation projections, suggesting LAI may be an additional useful tool for understanding climate change impacts. Going forward, users of LAI projections from the CMIP5 ESMs evaluated here should be aware that model outputs do not exhibit clear-cut relationships to vegetation carbon and precipitation. Our findings underscore the need for more attention to LAI projections, in terms of understanding the drivers of projected changes and improvements to model skill.

Various studies indicate that high-resolution oxygen A-band spectrum has the capability to retrieve the vertical profiles of aerosol and cloud properties. To improve the understanding of oxygen A-band inversions and utility, we developed a high-resolution oxygen A-band spectrometer (HABS), and deployed it at Howard University Beltsville site during the NASA Discover Air-Quality Field Campaign in July, 2011. By using a single telescope, the HABS instrument measures the direct solar and the zenith diffuse radiation subsequently. HABS exhibits excellent performance: stable spectral response ratio, high signal-to-noise ratio (SNR), high-spectrum resolution (0.016 nm), and high out-of-band rejection (10−5). For the spectral retrievals of HABS measurements, a simulator is developed by combining a discrete ordinates radiative transfer code (DISORT) with the High Resolution Transmission (HITRAN) database HITRAN2008. The simulator uses a double-k approach to reduce the computational cost. The HABS-measured spectra are consistent with the related simulated spectra. For direct-beam spectra, the discrepancies between measurements and simulations, indicated by confidence intervals (95%) of relative difference, are (−0.06, 0.05) and (−0.08, 0.09) for solar zenith angles of 27 and 72°, respectively. For zenith diffuse spectra, the related discrepancies between measurements and simulations are (−0.06, 0.05) and (−0.08, 0.07) for solar zenith angles of 27 and 72°, respectively. The main discrepancies between measurements and simulations occur at or near the strong oxygen absorption line centers. They are mainly due to two kinds of causes: (1) measurement errors associated with the noise/spikes of HABS-measured spectra, as a result of combined effects of weak signal, low SNR, and errors in wavelength registration; (2) modeling errors in the simulation, including the error of model parameters setting (e.g., oxygen absorption line parameters, vertical profiles of temperature and pressure) and the lack of treatment of the rotational Raman scattering. The high-resolution oxygen A-band measurements from HABS can constrain the active radar retrievals for more accurate cloud optical properties (e.g., cloud optical depth, effective radius), particularly for multi-layer clouds and for mixed-phase clouds.

Abstract Background and objectives Available evidence suggests that adults with chronic obstructive pulmonary disease (COPD) performed substantially worse than healthy controls on many balance measures and balance training can improve the balance measures in this population. We conducted this study to determine the effects of incorporating balance training into pulmonary rehabilitation (PR) on the incidence of falls at 12 months follow-up in high fall risk adults with COPD. Methods We conducted a prospective international multi-center randomized controlled trial. Eligible participants were adults with COPD at a high risk of future falls and were randomly assigned (1:1) to the intervention or control group. The intervention included personalized balance training for a targeted total of 90 min per week. Both the intervention and control groups received usual PR (2–3 times per week for 8–12 weeks). The primary outcome was the incidence of falls at 12-month follow-up using monthly fall diary calendars. Negative binomial regression or recurrent events models were used to examine the effects of the intervention on fall events. Multiple imputations were performed to deal with missing values. Results Of 258 participants who were enrolled in the trial, 178 provided falls information (intervention group = 91, control group = 87) and were included in the main analysis. Forty-one participants (45%) experienced at least one fall event in the intervention group and 33 (38%) in the control group (p = 0.34). The mean incidence of falls at 12 months was similar between the two groups (128 versus 128 per 100 person-years; mean difference: 0.30, 95% CI: -0.76 to 1.36 per 100 person-years). The results are robust after multiple imputations for missing data (n = 67). Conclusions PR incorporating balance training compared to PR alone did not reduce the incidence of falls over the 12-month period in high fall risk adults with COPD. Trial registration The study was registered with ClinicalTrials.gov (NCT02995681) on 14/12/2016.

Abstract Background Pulmonary rehabilitation (PR) is accepted as standard care for individuals with COPD. We conducted an international, multi-centred randomized controlled trial (RCT) to determine if adding balance training to PR would reduce the incidence of falls in people with COPD. While there have been many trials investigating the effectiveness of PR, few have involved international collaboration. Successful execution of rehabilitation trials requires a significant investment of time, staffing, and resources. With the recent completion of the Balance Training for Fall Reduction in COPD RCT, we report on the design, implementation, and execution of our trial using project management phases. We also highlight our lessons learned for consideration in future multi-centre rehabilitation trials. Methods This was a retrospective review of the planning, preparation, timelines, and personnel training involved in the execution of this study using four of the five project management phases described by Farrell et al. in 2010: (1) initiation, (2) planning, (3) execution, and (4) monitoring and controlling. We report descriptive statistics as percentages and counts and summarize our lessons learned. Results Ten outpatient PR programs in three continents participated. Thirty-one personnel worked on the trial across all sites. Enrolment began in January 2017 and was suspended in March 2020 due to the COVID-19 pandemic. Approximately 1275 patients were screened, 455 (36%) were eligible, 258 (57%) consented, 243 (53%) participated, and 130 (61%) completed the 12-month follow-up assessment. Lessons learned through our experience included (1) ensuring awareness of funder policies and considering the impact on collaborating sites; (2) preparing for the possibility of human resource and program disruptions; (3) anticipating site dropout and having a contingency plan in place; (4) planning and monitoring process measure data before, during, and after trial initiation; (5) ensuring frequent and consistent communication with and between collaborating sites; (6) maximizing features of database platform to ensure data set completeness and controlled data access; and (7) identifying strategies for increasing patient engagement in a high-demand study. Conclusions We identify seven lessons learned through our experience conducting an international, multicentre rehabilitation-based RCT. These lessons can provide guidance to other trialists conducting studies with similar logistics and may assist with future trial planning and implementation.

Abstract It is unclear whether polycystic ovary syndrome (PCOS) is an independent risk factor for adverse birth outcomes in the offspring of affected women. Here, we investigate the association of PCOS with birth outcomes in the offspring of women with PCOS overall and by potential confounders. This systematic review and meta-analysis included 73 studies and 92,881 offspring of women with and without PCOS from inception until 13th July 2022. We report that mothers with PCOS are younger and have higher body mass index (BMI) around conception and have greater gestational weight gain. The odds of preterm birth, fetal growth restriction and low birth weight are higher and mean birthweight is lower in PCOS of which a lower mean birthweight and a higher small for gestational age are probably independent of BMI. This work informed the recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome, emphasizing that PCOS status should be captured at pregnancy to identify risk and improve birth outcomes in the offspring.

Abstract Screening for polycystic ovary syndrome (PCOS) in antenatal care is inadequate, largely owing to the lack of clarity around whether PCOS is an independent risk factor for pregnancy complications. This systematic review and meta-analysis include 104 studies and 106,690 pregnancies in women with and without PCOS from inception until 13th July 2022. We report that women with PCOS are younger and have higher body mass index (BMI) around conception and have greater gestational weight gain. The odds of miscarriage, gestational diabetes mellitus, gestational hypertension, pre-eclampsia and cesarean section are higher in women with PCOS. The increased odds of adverse outcomes in PCOS remain significant when age and BMI are matched and when analyses are restricted to high-quality studies. This work informed the recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome, emphasizing that PCOS status should be captured in all women who are planning to, or have recently become pregnant to facilitate prevention of adverse outcomes and improve pregnancy outcomes.

Marine heatwaves are becoming more frequent during summer and pose a significant threat to coral reef ecosystems. Restoration efforts have the potential to support native coral populations and guard them against some degree of environmental change, while global action against climate change takes place. Interspecific hybridization is one approach through which resilient coral stock could be generated for restoration. Here we compared the performance of Acropora kenti and A. loripes hybrid and purebred coral recruits under a simulated thermal stress event. A. kenti eggs were successfully fertilized by A. loripes sperm to produce ‘KL’ hybrids, but no ‘LK’ hybrids could be produced from A. loripes eggs and A. kenti sperm. Despite corals in the elevated treatment accruing thermal stress (>12 degree heating weeks over 2 months) known to result in mass bleaching, both purebred and hybrid recruits showed no signs of stress under the simulated temperature regime, based on the performance indicators survivorship, size, color (a proxy of bleaching), and photochemical efficiency of photosystem II. Comparisons between the hybrids and purebreds studied here must be interpreted with caution because hybrid sample sizes were small. The hybrids did not outperform both of their purebred counterparts for any metrics studied here, demonstrating that there are limitations to the extent to which interspecific hybridization may boost the performance of coral stock. In general, the purebred A. loripes recruits performed best under both ambient and elevated conditions. The performance of the KL hybrid corals was similar to the maternal parental species, A. kenti, or not significantly different to either parental purebred species. The Symbiodiniaceae communities of the KL hybrids were characteristic of their maternal counterparts and may have underpinned the performance differences between the A. kenti/KL hybrid and A. loripes recruits.

Background: Health-related mobile applications (apps) have the potential to improve health knowledge and promote healthy behaviours during pregnancy. Pregnancy apps are popular and extensively used by consumers. Objective: This study investigates the usage patterns, decision-making criteria and concerns regarding the quality and credibility of health-related information within pregnancy mobile applications. The aim of this study is to understand consumer perspectives to potentially contribute to guidelines for apps containing health-related information. Design: A cross-sectional study, utilising an online questionnaire for data collection. Methods: The study surveyed pregnant women in Australia who were recruited via online platforms, including social media and paid Facebook ads. Participants completed a 29-item questionnaire assessing their use of pregnancy apps, sources of health information and perceptions of app quality and safety, with data collected and analysed using the Qualtrics platform and SPSS Statistics. Results: The survey was survey completed by 427 current-or-recently pregnant individuals, aged 18 or over and located in Australia. Overall, 62.3% were currently pregnant and 37.7% were recently pregnant, within 6 months. Medical practitioners were the primary source of pregnancy-related health information, and pregnancy apps were the third most common source. Pregnancy apps were considered to be a trustworthy source of information by 63.8% of respondents and the majority used apps during pregnancy (94.2%). Of those who used pregnancy apps ( n = 325), information being safe and trustworthy was their top priority when selecting an app. However, 35.5% ( n = 115) had encountered information in an app they felt was unsafe or conflicted with previous knowledge or advice. Only 4.6% ( n = 15) were aware that health-related apps are not screened for accurate information/undergo quality assurance checks before being made available to download. If provided with a guide to evaluate app quality, 74.6% ( n = 241) would utilise the tool. Conclusions: These findings highlight a need to promote the critical assessment of health information within pregnancy apps and to develop resources to support consumers in doing so.

BackgroundThere is a large number of research studies about the prevention of non-communicable diseases (NCD), with findings taking several years to be translated into practice. One reason for this lack of translation is a limited understanding of how to best disseminate NCD research findings to user-groups in a way that is salient and useful. An understanding of barriers and facilitators to dissemination is key to informing the development of strategies to increase dissemination. Therefore, this review aims to identify and synthesise the barriers and facilitators to dissemination of NCD research findings.MethodsA mixed studies systematic review was performed following JBI (formerly known as Joanna Briggs Institute) methodology. The search included articles from January 2000 until May 2021. We conducted a comprehensive search of bibliographic and grey literature of five databases to identify eligible studies. Studies were included if they involved end-users of public health research that were decision-makers in their setting and examined barriers/facilitators to disseminating research findings. Two pairs of reviewers mapped data from included studies against the Framework of Knowledge Translation (FKT) and used a convergent approach to synthesise the data.ResultsThe database search yielded 27,192 reports. Following screening and full text review, 15 studies (ten qualitative, one quantitative and four mixed methods) were included. Studies were conducted in 12 mostly high-income countries, with a total of 871 participants. We identified 12 barriers and 14 facilitators mapped to five elements of the FKT. Barriers related to: (i) the user-group (n = 3) such as not perceiving health as important and (ii) the dissemination strategies (n = 3) such as lack of understanding of content of guidelines. Several facilitators related to dissemination strategies (n = 5) such as using different channels of communication. Facilitators also related to the user-group (n = 4) such as the user-groups’ interest in health and research.ConclusionResearchers and government organisations should consider these factors when identifying ways to disseminate research findings to decision-maker audiences. Future research should aim to build the evidence base on different strategies to overcome these barriers.Systematic review registrationThe protocol of this review was deposited in Open Science Framework (https://doi.org/10.17605/OSF.IO/5QSGD).

Polluted runoff from informal settlements in developing countries poses a growing challenge due to the elevated and variable nature of contaminants, particularly nutrients and pathogens, introduced to the environment. Cost-effective and scalable treatment systems with the ability to reduce nutrient and other pollutant concentrations in contaminated runoff are desirable. Biofilters are passive water treatment systems that have the potential to achieve this. The Franschhoek Water Hub, a research site for nature-based solutions, features six large biofiltration cells designed to remediate runoff from an informal settlement. Due to their large size, understanding hydraulic behaviour and validating the design proves challenging. To address this, a scaled-down version of the Water Hub's biofilters was constructed to inform design criteria for purpose-built filters. The pilot-scale subsurface flow biofilter, filled with 8–11 mm aggregate stone, had an available volume of 225 L. Pulse tracer studies conducted at various flow rates demonstrated that the system approximated plug flow behaviour. Lower flow rates resulted in deeper tracer infiltration, which is crucial for maximising the distribution of nutrients within the filter bed. This research contributes to the effective design and operation of biofiltration systems, which hold promise for addressing surface water contamination issues in resource-constrained regions. HIGHLIGHTS Pulse tracer studies at various flow rates on a pilot-scale subsurface flow biofilter, mimicking the design of a field-scale system, investigated fluid flow behaviour in a field-scale system.; The extent of plug flow behaviour and degree of mixing in the radial direction increased with decreasing flow rate.; Low operational flow rates ensure greater utilisation of the active filter bed.;

Sydnones are a class of mesoionic compounds containing a five-membered heterocyclic ring. In general, sydnone compounds are synthesized with an aromatic substutuent at the N3 position. This feature, adds to the stability of the heterocyclic ring. In the title compound {systematic name: 4-(2-bromopropanoyl)-3-phenyl-1,2,3λ5-oxadiazol-3-ylium-5-olate}, C11H9BrN2O3, the aromatic substitutent is an unsubstituted phenyl ring. The sydnone ring is almost planar, with a maximum deviation from the mean plane of 0.023 (1) Å, but is not coplanar with the phenyl ring, having a dihedral angle of 40.93 (8)°. The carbonyl side chain is twisted relative to the syndone ring by 15.8 (2)°. The molecules are packed in the unit cell as pairs related by an inversion center at (1, 0, 1/2). The pairs interact via π-stacking, with the distance separating the centroids being 3.824 (1) Å. The Br atom has two contacts, one to an N atom in a neighboring asymmetric unit with a distance of 3.346 (2) Å (the sum of the van der Waals radii is 3.40 Å) and a second to an H atom with a distance of 3.03 Å. The contact with the H atom is perpendicular (C—Br...H = 98.60°) to the C—Br bond, and that to the N atom is linear [C—Br...N = 169.10 (5)°] to the C—Br bond. The O atom of the sydnone ring is involved in two hydrogen bonds, one intramolecular with a donor–acceptor distance of 3.1486 (19) Å and a second that is intermolecular, with a phenyl H atom as the donor and has a donor–acceptor distance of 3.346 (2) Å.

Background: Women with cardiometabolic pregnancy complications are at increased risk of future diabetes and heart disease which can be reduced through lifestyle management postpartum. Objectives: This study aimed to explore preferred intervention characteristics and behaviour change needs of women with or without prior cardiometabolic pregnancy complications for engaging in postpartum lifestyle interventions. Design: Quantitative cross-sectional study. Methods: Online survey. Results: Overall, 473 women were included, 207 (gestational diabetes (n = 105), gestational hypertension (n = 39), preeclampsia (n = 35), preterm birth (n = 65) and small for gestational age (n = 23)) with and 266 without prior cardiometabolic pregnancy complications. Women with and without complications had similar intervention preferences, with delivery ideally by a healthcare professional with expertise in women’s health, occurring during maternal child health nurse visits or online, commencing 7 weeks to 3 months post birth, with 15- to 30-min monthly sessions, lasting 1 year and including monitoring of progress and social support. Women with prior complications preferred intervention content on women’s health, mental health, exercise, mother’s diet and their children’s health and needed to know more about how to change behaviour, have more time to do it and feel they want to do it enough to participate. There were significant differences between groups, with more women with prior cardiometabolic pregnancy complications wanting content on women’s health (87.9% vs 80.8%, p = 0.037), mother’s diet (72.5% vs 60.5%, p = 0.007), preventing diabetes or heart disease (43.5% vs 27.4%, p

Summary:. Pediatric hand burns are difficult to treat, with thin tissue with critical structures close to the skin and the small scale of the anatomy of children’s hands. Additionally, pediatric burns can be challenging due to the concern for donor-site morbidity and the paucity of donor sites when reconstructing these wounds. In this report, we discuss the successful application of a piscine-derived acellular dermal matrix in a 13-month-old child with deep partial thickness and full-thickness burns to the right upper extremity. She had excellent long term cosmetic results and function by 3 years postoperatively, including full extension and flexion of all digits in her right hand.

Introduction This review quantifies the mean treatment effect of exercise-based interventions on balance and falls risk in people with COPD. Methods A structured search strategy (2000–2023) was applied to eight databases to identify studies evaluating the impact of exercise-based interventions (≥14 days in duration) on balance or falls in people with COPD. Pooled mean treatment effects (95% confidence intervals (CIs), 95% prediction intervals (PIs)) were calculated for outcomes reported in five or more studies. Inter-individual response variance and the promise of behaviour change techniques (BCTs) were explored. Results 34 studies (n=1712) were included. There were greater improvements in balance post intervention compared to controls for the Berg Balance Scale (BBS) (mean 2.51, 95% CI 0.22–4.80, 95% PI −4.60–9.63), Timed Up and Go (TUG) test (mean −1.12 s, 95% CI −1.69– −0.55 s, 95% PI −2.78–0.54 s), Single-Leg Stance (SLS) test (mean 3.25 s, 95% CI 2.72–3.77 s, 95% PI 2.64–3.86 s) and Activities-specific Balance Confidence (ABC) scale (mean 8.50%, 95% CI 2.41–14.58%, 95% PI −8.92–25.92%). Effect on falls remains unknown. Treatment effects were larger in male versus mixed-sex groups for the ABC scale and SLS test, and in balance training versus other exercise-based interventions for the BBS and TUG test. Falls history was not associated with changes in balance. Meta-analysis of individual response variance was not possible and study-level results were inconclusive. Eleven promising BCTs were identified (promise ratio ≥2). Conclusion Evidence for the effect of exercise-based interventions eliciting clinically important improvements in balance for people with COPD is weak, but targeted balance training produces the greatest benefits. Future exercise interventions may benefit from inclusion of the identified promising BCTs.

Background Enhanced detection of large vessel occlusion (LVO) through machine learning (ML) for acute ischemic stroke appears promising. This systematic review explored the capabilities of ML models compared with prehospital stroke scales for LVO prediction. Methods and Results Six bibliographic databases were searched from inception until October 10, 2023. Meta‐analyses pooled the model performance using area under the curve (AUC), sensitivity, specificity, and summary receiver operating characteristic curve. Of 1544 studies screened, 8 retrospective studies were eligible, including 32 prehospital stroke scales and 21 ML models. Of the 9 prehospital scales meta‐analyzed, the Rapid Arterial Occlusion Evaluation had the highest pooled AUC (0.82 [95% CI, 0.79–0.84]). Support Vector Machine achieved the highest AUC of 9 ML models included (pooled AUC, 0.89 [95% CI, 0.88–0.89]). Six prehospital stroke scales and 10 ML models were eligible for summary receiver operating characteristic analysis. Pooled sensitivity and specificity for any prehospital stroke scale were 0.72 (95% CI, 0.68–0.75) and 0.77 (95% CI, 0.72–0.81), respectively; summary receiver operating characteristic curve AUC was 0.80 (95% CI, 0.76–0.83). Pooled sensitivity for any ML model for LVO was 0.73 (95% CI, 0.64–0.79), specificity was 0.85 (95% CI, 0.80–0.89), and summary receiver operating characteristic curve AUC was 0.87 (95% CI, 0.83–0.89). Conclusions Both prehospital stroke scales and ML models demonstrated varying accuracies in predicting LVO. Despite ML potential for improved LVO detection in the prehospital setting, application remains limited by the absence of prospective external validation, limited sample sizes, and lack of real‐world performance data in a prehospital setting.

Background Type 2 diabetes mellitus (T2DM) is a global public health crisis impacting low-income and middle-income countries such as Bangladesh. While self-management is encouraged for individuals with T2DM, there is a significant lack of knowledge regarding the factors of facilitators, barriers and expectations associated with T2DM self-management in Bangladesh. This research aims to investigate the potential elements that support, impede and are anticipated in the effective practice of self-management for T2DM in rural areas of Bangladesh.Methods and analysis This study will use an exploratory qualitative approach. 16 focus group discussions, 13 in-depth interviews and 9 key informant interviews will be conducted among multilevel stakeholders, including people with T2DM, their caregivers, healthcare providers, health managers/administrators and policy planners. Interviews will be audio-recorded, transcribed, translated and analysed using thematic analysis.Ethics and dissemination This research project has been approved by the Monash University Human Research Ethics Committee (project reference number: 39483) and the Ethical Review Committee of the Centre for Injury Prevention and Research, Bangladesh (Memo: CIPRB/ERC/2023/14). Research findings will be disseminated in peer-reviewed journals and conference presentations. Published reports will include group data. Individual data privacy will be strictly maintained.

Consumer and community involvement (CCI) in preventive research and health initiatives is not only encouraged but is expected within a rapidly evolving landscape across health policy, practice and research. Here, we summarise the fundamental principles of CCI, as well as outline the barriers and current developments in working towards best practices at organisational and systems levels. CCI stands at a critical juncture. Best practice emphasises meaningful partnerships with consumers and communities to deliver impactful research and prevention activities, yet complex challenges and systematic barriers remain. We need further evidence to demonstrate both ‘what’ and ‘how’ CCI should be best implemented in these settings. We present key considerations for researchers, organisations and systems to catalyse the transition of CCI from mere recognition of its importance to pragmatic and optimum implementation and, ultimately, to systemic reform. These include changes to capacity building, funding structures, equitable engagement and transparent evaluation. These must be underpinned by evidence-based approaches, partnership, trust and broad consensus processes to achieve meaningful and impactful CCI in research and healthcare improvement through a lens of inclusivity.

Successful research-policy partnerships rely on shared vision, dedicated investment, and mutual benefits. To ensure the ongoing value of chronic disease prevention research, and support research translation and impact, Australia needs funding, university, and policy systems that incentivise and support emerging leaders to drive effective partnerships.

Abstract Background Telemonitoring for the remote patient self-management of chronic conditions can be a cost-effective method for delivering care in chronic disease; nonetheless, its implementation in clinical practice remains low. The aim of this meta-synthesis is to explore barriers and facilitators associated with the use of remote patient monitoring of chronic disease, drawing on qualitative research, and assessing participant interactions with this technology. Method A meta-synthesis of qualitative studies was performed. MEDLINE, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database date of inception to 5 February 2021. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. Thematic synthesis was performed to identify user (patients, carers and healthcare professionals) perspectives and experiences of patient remote monitoring of chronic disease (Type 2 diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease). Results Searches returned 10,401 studies and following independent screening by two reviewers, nine studies were included in this meta-synthesis. Data were synthesised and categorised into four key themes: (1) Improved care; (2) Communication; (3) Technology feasibility & acceptability; and (4) Intervention concerns. Most patients using patient remote devices felt motivated in managing their own lifestyles and felt reassured by the close monitoring and increased communication. Barriers identified involved generational differences and difficulties with the technology used. Conclusion Most studies showed a positive attitude to telemonitoring, with patients preferring the convenience of telemonitoring in comparison to attending regular clinics. Further research is required to assess the most effective technology for chronic disease management, how to maintain long-term patient adherence, and identify effective approaches to address generational variation in telemonitoring up-take.

Abstract Metagenomic or metabarcoding data are often used to predict microbial interactions in complex communities, but these predictions are rarely explored experimentally. Here, we use an organism abundance correlation network to investigate factors that control community organization in mine tailings-derived laboratory microbial consortia grown under dozens of conditions. The network is overlaid with metagenomic information about functional capacities to generate testable hypotheses. We develop a metric to predict the importance of each node within its local network environments relative to correlated vitamin auxotrophs, and predict that a Variovorax species is a hub as an important source of thiamine. Quantification of thiamine during the growth of Variovorax in minimal media show high levels of thiamine production, up to 100 mg/L. A few of the correlated thiamine auxotrophs are predicted to produce pantothenate, which we show is required for growth of Variovorax, supporting that a subset of vitamin-dependent interactions are mutualistic. A Cryptococcus yeast produces the B-vitamin pantothenate, and co-culturing with Variovorax leads to a 90-130-fold fitness increase for both organisms. Our study demonstrates the predictive power of metagenome-informed, microbial consortia-based network analyses for identifying microbial interactions that underpin the structure and functioning of microbial communities.

Diabetes mellitus (DM) poses a significant challenge to public health. Effective diabetes self-management education (DSME) interventions may play a pivotal role in the care of people with type 2 diabetes mellitus (T2DM) in low- and middle-income countries (LMICs). A specific up-to-date systematic review is needed to assess the effect of DSME interventions on glycaemic control, cardiometabolic risk, self-management behaviours, and psychosocial well-being among T2DM across LMICs. The MEDLINE, Embase, CINAHL, Global Health, and Cochrane databases were searched on 02 August 2022 and then updated on 10 November 2023 for published randomised controlled trials (RCTs) and quasi-experimental studies. The quality of the studies was assessed, and a random-effect model was used to estimate the pooled effect of diabetes DSME intervention. Heterogeneity (I2) was tested, and subgroup analyses were performed. Egger's regression test and funnel plots were used to examine publication bias. The risk of bias of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trial (RoB 2). The overall assessment of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. A total of 5893 articles were retrieved, and 44 studies (n = 11838) from 21 LMICs met the inclusion criteria. Compared with standard care, pooled analysis showed that DSME effectively reduced the HbA1c level by 0.64% (95% CI: 0.45% to 0.83%) and 1.27% (95% CI: -0.63% to 3.17%) for RCTs and quasi-experimental design studies, respectively. Further, the findings showed an improvement in cardiometabolic risk reduction, diabetes self-management behaviours, and psychosocial well-being. This review suggests that ongoing support alongside individualised face-to-face intervention delivery is favourable for improving overall T2DM management in LMICs, with a special emphasis on countries in the lowest income group.

BackgroundDespite pharmacological therapies to improve outcomes of pulmonary hypertension (PH), poor long-term survival remains. Exercised-based cardiac rehabilitation (ExCR) may be an alternative strategy to improve prognosis. Therefore, using an electronic medical record (EMR) database, the objective of this study was to compare mortality between patients with primary PH with ExCR vs. propensity-matched PH patients without ExCR.MethodsThe retrospective analysis was conducted on February 15, 2023 using anonymized data within TriNetX, a global federated health research network. All patients were aged ≥18 years with primary PH recorded in EMRs with at least 1-year follow-up from ExCR. Using logistic regression models, patients with PH with an EMR of ExCR were 1:1 propensity score-matched with PH patients without ExCR for age, sex, race, and comorbidities, and cardiovascular care.ResultsIn total, 109,736 patients with primary PH met the inclusion criteria for the control group and 784 patients with primary PH met the inclusion criteria for the ExCR cohort. Using the propensity score-matched cohorts, 1-year mortality from ExCR was proportionally lower with 13.6% (n = 101 of 744 patients) in the ExCR cohort compared to 23.3% (n = 174 of 747 patients) in the controls (OR 0.52, 95% CI 0.40–0.68).ConclusionThe present study of 1,514 patients with primary PH suggests that ExCR is associated with 48% lower odds of 1-year mortality, when compared to propensity score-matched patients without ExCR.

Abstract Background Dissemination is a critical element of the knowledge translation pathway, and a necessary step to ensure research evidence is adopted and implemented by key end users in order to improve health outcomes. However, evidence-based guidance to inform dissemination activities in research is limited. This scoping review aimed to identify and describe the scientific literature examining strategies to disseminate public health evidence related to the prevention of non-communicable diseases. Methods Medline, PsycInfo and EBSCO Search Ultimate were searched in May 2021 for studies published between January 2000 and the search date that reported on the dissemination of evidence to end users of public health evidence, within the context of the prevention of non-communicable diseases. Studies were synthesised according to the four components of Brownson and colleagues’ Model for Dissemination of Research (source, message, channel and audience), as well as by study design. Results Of the 107 included studies, only 14% (n = 15) directly tested dissemination strategies using experimental designs. The remainder primarily reported on dissemination preferences of different populations, or outcomes such as awareness, knowledge and intentions to adopt following evidence dissemination. Evidence related to diet, physical activity and/or obesity prevention was the most disseminated topic. Researchers were the source of disseminated evidence in over half the studies, and study findings/knowledge summaries were more frequently disseminated as the message compared to guidelines or an evidence-based program/intervention. A broad range of dissemination channels were utilised, although peer-reviewed publications/conferences and presentations/workshops predominated. Practitioners were the most commonly reported target audience. Conclusions There is a significant gap in the peer reviewed literature, with few experimental studies published that analyse and evaluate the effect of different sources, messages and target audiences on the determinants of uptake of public health evidence for prevention. Such studies are important as they can help inform and improve the effectiveness of current and future dissemination practices in public health contexts.

Plain English summary Talking about breathlessness can be difficult and cause feelings of anxiety. Involving people with breathlessness in research activities can also be challenging. Research contexts can make people feel uncomfortable as they may struggle to understand and feel like they don’t belong. Comic-based illustration (cartooning) offers an opportunity to communicate in a different way. Cartooning was used with members of Breathe Easy Darlington, a support group for people with breathlessness, as a way of helping the research team understand how breathlessness impacts daily lives. Five 90-min cartooning workshops were delivered online and involved 5–10 Breathe Easy members per session. The sessions were led by a professional cartoonist whilst the research team facilitated discussions about breathlessness and related issues. The experience of living with breathlessness was illustrated via cartoon characters and ideas were explored through conversations about the illustrations. People found cartooning fun and sharing the experience with the research team helped them to become part of an existing group who will support a long-term research project directly impacting research investigating balance in people with lung disease. The Breathe Easy members were able to tell their stories via illustrations allowing the research team an insight into different aspects of living with breathlessness. The illustrations showed characters leaning against trees and chairs, sweating and sitting down. The need for physical support caused embarrassment, while people struggled to appear “normal”. Conversations about the illustrations revealed that the idea of “balance” aligns with a loss of control, disorientation, and unsteadiness which causes intense fear and shame.

Objective Pregnant women are increasingly turning to apps targeting knowledge and behaviour change for supporting healthy lifestyles and managing medical conditions. Yet, there is growing concern over the credibility and safety of content within mobile health (mHealth) apps. This scoping review aimed to systematically and thematically consolidate safety considerations described in reviews evaluating pregnancy-specific apps. Methods PubMed, Ovid MEDLINE® and EPub, CINAHL, Web of Science, Cochrane Libraries, and SCOPUS were systematically searched to identify reviews that assessed apps targeting pregnant women. Data related to safety were extracted and thematically analysed to establish a set of relevant safety considerations. Results Sixteen reviews met the inclusion criteria. The included reviews assessed an average of 27 apps each and targeted pregnancy topics, such as nutrition and physical activity. Five major and 20 minor themes were identified, including information, transparency, credibility, privacy and security, and app tailoring. Information, transparency, and credibility relate to the evidence base of information within the app, privacy and security of apps relate to the protection of personal information and data, and app tailoring relates to the consideration of contextual factors, such as local guidelines and digital health literacy. Conclusions Results present possible safety considerations when evaluating pregnancy-specific apps and emphasise a clear need for consumer guidance on how to make informed decisions around engagement and use of mHealth apps during pregnancy.

Australia and New Zealand have the highest incidence of skin cancer. Sport is a fundamental part of Australasian culture, beginning in childhood, often with life-long participation. Participating in outdoor sports can contribute significantly to the lifetime ultraviolet radiation (UVR) dose individuals receive and their risk of developing skin cancer. This systematic scoping review explores the use of sun-protection by outdoor sporting participants in Australasia and considers how sun-protection practices may be improved and better evaluated in the community. A search of electronic databases using the search strategy “sun protection” AND “sport” AND “Australia” yielded 17 studies published in English from January 1992 to August 2021. Study methods included using UV-dosimeters to measure individual UVR-exposure; remote estimates of clothing-adjusted UVR-exposure; direct observation of sun-protection practices; and self-reported sun-exposure and sun-protection. Despite 40 years of ‘Slip, Slop, Slap’ campaigns in Australia, the use of sun-protection in most outdoor sports is inadequate. The paucity of comparable data limited our analyses, demonstrating a need for standardized, objective evaluation tools. Such tools, if used across a range of sports, should inform the development of workable recommendations that sporting clubs could implement and adopt into policy, thus empowering them to better protect the health of their participants.

Abstract The spongy moth Lymantria dispar, formerly known as the gypsy moth, is a forest pest that occurs as two different biotypes: the European spongy moth (ESM), Lymantria dispar dispar, which is distributed in Europe and North America; and the Asian spongy moth (ASM), which consists of subspecies Lymantria dispar asiatica and Lymantria dispar japonica and is distributed in China, Russia, Korea, and Japan. The Asian biotype is classified as a quarantine pest by the U.S. Department of Agriculture because of the superior flight ability of adult females compared to females of the European biotype. To identify genes that potentially account for differences in female flight capability between the two biotypes, we assembled and compared transcriptional profiles of two North American populations of ESM and two Chinese populations of ASM, including samples of unmated female adults and females after mating and oviposition. Of 129,286 unigenes identified, 306 were up-regulated in ASM samples relative to ESM, including genes involved in egg production. In contrast, 2309 unigenes were down-regulated in ASM samples, including genes involved in energy production. Although a previous study found that ASM female flight was reduced after oviposition, a comparison of gene expression before and after mating and oviposition did not reveal any genes which were consistently up- or down-regulated in the two ASM populations.

Summary: DISC1 is a genetic risk factor for multiple psychiatric disorders. Compared to the dozens of murine Disc1 models, there is a paucity of zebrafish disc1 models—an organism amenable to high-throughput experimentation. We conducted the longitudinal neurobehavioral analysis of disc1 mutant zebrafish across key stages of life. During early developmental stages, disc1 mutants exhibited abrogated behavioral responses to sensory stimuli across multiple testing platforms. Moreover, during exposure to an acoustic sensory stimulus, loss of disc1 resulted in the abnormal activation of neurons in the pallium, cerebellum, and tectum—anatomical sites involved in the integration of sensory perception and motor control. In adulthood, disc1 mutants exhibited sexually dimorphic reduction in anxiogenic behavior in novel paradigms. Together, these findings implicate disc1 in sensorimotor processes and the genesis of anxiogenic behaviors, which could be exploited for the development of novel treatments in addition to investigating the biology of sensorimotor transformation in the context of disc1 deletion.

Background:. Cranioplasty is a common surgical procedure used to repair cranial defects, and it is associated with significant morbidity and mortality. Although frailty is a strong predictor of poor postoperative outcomes across surgical specialties, little is known about frailty’s impact on cranioplasty outcomes. This study examined the association between frailty and cranioplasty by comparing the effect of the Risk Analysis Index-Administrative (RAI-A) and the Modified Frailty Index-5 (mFI-5) on cranioplasty outcomes. Methods:. The National Surgical Quality Improvement Program was queried for patients undergoing cranioplasty between 2012 and 2020. Receiver operating characteristics and multivariable analyses were used to assess the relationship of postoperative outcomes and the RAI-A, mFI-5, and increasing patient age. Results:. There were 2864 included study patients with a median age of 57 years (IQR, 44-67), and a higher proportion of patients were women (57.0%) and White (68.5%). The RAI-A had a more robust predictive ability for 30-day mortality (C-Statistic, 0.741; 95% confidence interval (CI), 0.678‐0.804) compared with mFI-5 (C-Statistic, 0.574; 95% CI, 0.489‐0.659) and increasing patient age (C-Statistic, 0.671; 95% CI, 0.610‐0.732). On multivariable analyses, frailty was independently associated with mortality and other poor postoperative outcomes (P < 0.05). Conclusions:. The RAI-A demonstrated superior discrimination than the mFI-5 and increasing patient age in predicting mortality. Additionally, the RAI-A showed independent associations with nonhome discharge and postoperative complications (CDII, CDIIIb, and CDIV). The high rates of operative morbidity (5.0%–36.5%) and mortality (0.4%–3.2%) after cranioplasty highlight the importance of identifying independent risk factors for poor cranioplasty outcomes.

In this paper we explore the potential of academic podcasting to effect positive change within academia and between academia and society. Building on the concept of “epistemic living spaces,” we consider how podcasting can change how we evaluate what is legitimate knowledge and methods for knowledge production, who has access to what privileges and power, the nature of our connections within academia and with other partners, and how we experience the constraints and opportunities of space and time. We conclude by offering a guide for others who are looking to develop their own academic podcasting projects and discuss the potential for podcasting to be formalized as a mainstream academic output. To listen to an abridged and annotated version of this paper, visit: https://soundcloud.com/conservechange/podcastinginacademia.

Introduction: Studies in humans and animals have found that type 2 diabetes mellitus (T2DM) exaggerates the blood pressure (BP) response to exercise, which increases the risk of adverse cardiovascular events such as heart attack and stroke. T2DM is a chronic disease that, without appropriate management, progresses in severity as individuals grow older. Thus, it is possible that aging may also exaggerate the BP response to exercise. Therefore, the purpose of the current study was to determine the effect of the pathophysiology of T2DM on the exercise pressor reflex independent of aging.Methods: We compared changes in peak pressor (mean arterial pressure; ΔMAP), BP index (ΔBPi), heart rate (ΔHR), and HR index (ΔHRi) responses to static contraction, intermittent contraction, and tendon stretch in UCD-T2DM rats to those of healthy, age-matched Sprague Dawley rats at three different stages of the disease.Results: We found that the ΔMAP, ΔBPi, ΔHR, and ΔHRi responses to static contraction were significantly higher in T2DM rats (ΔMAP: 29 ± 4 mmHg; ΔBPi: 588 ± 51 mmHg•s; ΔHR: 22 ± 5 bpm; ΔHRi: 478 ± 45 bpm•s) compared to controls (ΔMAP: 10 ± 1 mmHg, p < 0.0001; ΔBPi: 121 ± 19 mmHg•s, p < 0.0001; ΔHR: 5 ± 2 bpm, p = 0.01; ΔHRi: 92 ± 19 bpm•s, p < 0.0001) shortly after diabetes onset. Likewise, the ΔMAP, ΔBPi, and ΔHRi to tendon stretch were significantly higher in T2DM rats (ΔMAP: 33 ± 7 mmHg; ΔBPi: 697 ± 70 mmHg•s; ΔHRi: 496 ± 51 bpm•s) compared to controls (ΔMAP: 12 ± 5 mmHg, p = 0.002; ΔBPi: 186 ± 30 mmHg•s, p < 0.0001; ΔHRi: 144 ± 33 bpm•s, p < 0.0001) shortly after diabetes onset. The ΔBPi and ΔHRi, but not ΔMAP, to intermittent contraction was significantly higher in T2DM rats (ΔBPi: 543 ± 42 mmHg•s; ΔHRi: 453 ± 53 bpm•s) compared to controls (ΔBPi: 140 ± 16 mmHg•s, p < 0.0001; ΔHRi: 108 ± 22 bpm•s, p = 0.0002) shortly after diabetes onset.Discussion: Our findings suggest that the exaggerated exercise pressor reflex and mechanoreflex seen in T2DM are due to the pathophysiology of the disease and not aging.

Em várias regiões do interior do Estado de São Paulo, notificou-se a partir do final de 1984 a 1986, a ocorrência de doença até então desconhecida, com características clínicas, em muitos aspectos, semelhante à meningococcemia. Esta síndrome foi denominada Febre Purpúrica Brasileira (FPB). Em quinze dos casos com quadro clínico compatível com a síndrome, o Haemophilus aegyptius foi isolado a partir de culturas de sangue, de líquido cefalorraquidiano sanguinolento, de secreção conjuntival e orofaríngea. Analisa-se a importância deste achado, face à existência de somente um relato na literatura, de infecção sistêmica por bactérias desta espécie.

BackgroundTelemedicine is an expanding and feasible approach to improve medical care for patients with long-term conditions. However, there is a poor understanding of patients’ acceptability of this technology and their rate of uptake. ObjectiveThe aim of this study was to systematically review the current evidence on telemonitoring in the management of patients with long-term conditions and evaluate the patients’ uptake and acceptability of this technology. MethodsMEDLINE, Scopus, and CENTRAL (the Cochrane Central Register of Controlled Trials) were searched from the date of inception to February 5, 2021, with no language restrictions. Studies were eligible for inclusion if they reported any of the following outcomes: intervention uptake and adherence; study retention; patient acceptability, satisfaction, and experience using the intervention; changes in physiological values; all-cause and cardiovascular-related hospitalization; all-cause and disease-specific mortality; patient-reported outcome measures; and quality of life. In total, 2 reviewers independently assessed the articles for eligibility. ResultsA total of 96 studies were included, and 58 (60%) were pooled for the meta-analyses. Meta-analyses showed a reduction in mortality (risk ratio=0.71, 95% CI 0.56-0.89; P=.003; I2=0%) and improvements in blood pressure (mean difference [MD]=−3.85 mm Hg, 95% CI −7.03 to −0.68; P=.02; I2=100%) and glycated hemoglobin (MD=−0.33, 95% CI −0.57 to −0.09; P=.008; I2=99%) but no significant improvements in quality of life (MD=1.45, 95% CI −0.10 to 3; P=.07; I2=80%) and an increased risk of hospitalization (risk ratio=1.02, 95% CI 0.85-1.23; P=.81; I2=79%) with telemonitoring compared with usual care. A total of 12% (12/96) of the studies reported adherence outcomes, and 9% (9/96) reported on satisfaction and acceptance outcomes; however, heterogeneity in the assessment methods meant that a meta-analysis could not be performed. ConclusionsTelemonitoring is a valid alternative to usual care, reducing mortality and improving self-management of the disease, with patients reporting good satisfaction and adherence. Further studies are required to address some potential concerns regarding higher hospitalization rates and a lack of positive impact on patients’ quality of life. Trial RegistrationPROSPERO CRD42021236291; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=236291

BackgroundDigital health resources have the potential to assist women in optimizing gestational weight gain (GWG) during pregnancy to improve maternal health outcomes. ObjectiveIn this study, we aimed to evaluate the quality and behavior change potential of publicly available digital tools (websites and apps) that facilitate GWG tracking. MethodsDigital tools were identified using key search terms across website search engines and app stores and evaluated using the Mobile App Rating Scale, the App Behavior Change Scale, as well as criteria to evaluate the rigor and safety of GWG information. ResultsOverall, 1085 tools were screened for inclusion (162 websites and 923 apps), and 19 were deemed eligible. The mean Mobile App Rating Scale quality score was 3.31 (SD 0.53) out of 5, ranging from 2.26 to 4.39, and the mean App Behavior Change Scale score was 6 (SD 3.4) out of 21, ranging from 19 to 0. Of the 19 items used to evaluate rigor of GWG advice, most tools (n=11, 57.9%) contained ≤3 items. ConclusionsThis review emphasizes the substantial limitations in current digital resources promoting the monitoring and optimization of GWG. Most tools were of low quality, had minimal behavior change potential, and were potentially unsafe, with minimal linkage to evidence-based information or partnership with health care.

Semi-passive bioremediation is a promising strategy to mitigate persistent low volume mine-impacted wastewater containing high sulphate concentrations. Building on the proof of concept demonstration of the hybrid linear flow channel reactor (LFCR), capable of simultaneous biological sulphate reduction and partial sulphide oxidation with elemental sulphur recovery, the impact of key operating parameters, such as temperature, on process performance is critical to real-world application. Temperature fluctuates seasonally and across the diurnal cycle, impacting biological sulphate reduction (BSR) and partial sulphide oxidation. The process is reliant on the metabolic activity and synergistic interactions between sulphate-reducing (SRB) and sulphide-oxidising (SOB) microbial communities that develop within discrete oxic and anoxic microenvironments within the hybrid LFCR. In this study, the impact of operating temperature on process performance was evaluated by decreasing temperature with time from 30 to 10°C in each of three laboratory-scaled hybrid LFCR units operating in pseudo-steady state at 1 g/L sulphate. Using lactate as a carbon source, two reactor sizes (2 and 8 L) were considered, while the impact of lactate vs. acetate as carbon source was evaluated in the 2 L reactors. On incremental decrease in temperature from 30 to 10°C, a decrease in volumetric sulphate reduction rate was observed: from 0.144 to 0.059 mmol/L.h in the 2 L lactate-fed reactor; from 0.128 to 0.042 mmol/L.h in the 8 L lactate-fed reactor; and from 0.127 to 0.010 mmol/L.h in the 2 L acetate-fed reactor. Similarly, sulphate conversion efficiency decreased (2 L lactate-fed: 66% to 27%; 8 L lactate-fed: 61% to 20%; 2 L acetate-fed: 61% to 5%). A decrease in temperature below the critical value (15°C) led to considerable loss in metabolic activity and overall BSR performance. Sessile and planktonic microbial communities were represented by bacterial phyla including Proteobacteria, Synergistetes, Bacteroidetes, and Firmicutes. A diverse group of putative SRB (Deltaproteobacteria) and SOB, including Alpha, Beta, Gamma, and Epsilonproteobacteria phylotypes, were prevalent and shifted in relative abundance and community composition in response to decreasing temperature. Specifically, the decrease in the relative abundance of Deltaproteobacteria with decreasing temperature below 15°C corresponded with a loss of BSR performance across all three reactors. This study demonstrated the impact of low temperature on the physiological selection and ecological differentiation of SRB and SOB communities within the hybrid LFCR and its implications for real-world process performance.

In this Perspective, Dimitrios Sagris, Stephanie Harrison, and Gregory Lip discuss new evidence concerning the paradoxical relationship between circulating lipids and atrial fibrillation.

BackgroundReproductive-aged women are a high-risk population group for accelerated weight gain and obesity development, with pregnancy recognized as a critical contributory life-phase. Healthy lifestyle interventions during the antenatal period improve maternal and infant health outcomes, yet translation and implementation of such interventions into real-world health care settings remains limited. ObjectiveWe aim to generate key implementation learnings to inform the feasibility of future scale up and determine the effectiveness of intervention delivery methods on engagement, experience, acceptability, knowledge, risk perception, health literacy, and modifiable weight-related health behaviors in women during preconception, pregnancy, and postpartum periods. MethodsThis randomized hybrid implementation effectiveness study will evaluate the penetration, reach, feasibility, acceptability, adoption, and fidelity of a healthy lifestyle intervention (OptimalMe) implemented into, and in partnership with, private health care. Individual health outcomes associated with implementation delivery mode, including knowledge, risk perception, health literacy, self-management, and health behaviors, are secondary outcomes. A total of 300 women aged 18 to 44 years, who are not pregnant but wish to conceive within the next 12 months, and with access to the internet will be recruited. All participants will receive the same digital lifestyle intervention, OptimalMe, which is supported by health coaching and text messages during preconception, pregnancy, and postpartum periods. We will use a parallel 2-arm design to compare telephone with videoconference remote delivery methods for health coaching. Methods are theoretically underpinned by the Consolidated Framework for Implementation Research and outcomes based on the Reach, Engagement, Adaptation, Implementation and Maintenance framework. ResultsThe study was approved on August 16, 2019 and has been registered. Recruitment commenced in July 2020, and data collection is ongoing. Results are expected to be published in 2022. ConclusionsThe study’s design aligns with best practice implementation research. Results will inform translation of evidence from randomized controlled trials on healthy lifestyle interventions into practice targeting women across preconception, pregnancy, and postpartum periods. Learnings will target consumers, program facilitators, health professionals, services, and policy makers to inform future scale up to ultimately benefit the health of women across these life-phases. Trial RegistrationAustralian and New Zealand Clinical Trial Registry ACTRN12620001053910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378243&isReview=true International Registered Report Identifier (IRRID)DERR1-10.2196/33625

The spongy moth virus Lymantria dispar iflavirus 1 (LdIV1), originally identified from a Lymantria dispar cell line, was detected in 24 RNA samples from female moths of four populations from the USA and China. Genome-length contigs were assembled for each population and compared with the reference genomes of the first reported LdIV1 genome (Ames strain) and two LdIV1 sequences available in GenBank originating from Novosibirsk, the Russian Federation. A whole-genome phylogeny was generated for these sequences, indicating that LdIV1 viruses observed in North American (flightless) and Asian (flighted) spongy moth lineages indeed partition into clades as would be expected per their host’s geographic origin and biotype. A comprehensive listing of synonymous and non-synonymous mutations, as well as indels, among the polyprotein coding sequences of these seven LdIV1 variants was compiled and a codon-level phylogram was computed using polyprotein sequences of these, and 50 additional iflaviruses placed LdIV1 in a large clade consisting mostly of iflaviruses from other species of Lepidoptera. Of special note, LdIV1 RNA was present at very high levels in all samples, with LdIV1 reads accounting for a mean average of 36.41% (ranging from 1.84% to 68.75%, with a standard deviation of 20.91) of the total sequenced volume.

Rice (Oryza sativa L.) is an important food crop relied upon by billions of people worldwide. However, with increasing pressure from climate change and rapid population growth, cultivation is very water-intensive. Therefore, it is critical to produce rice that is high-yielding and genetically more water-use efficient. Here, using the stabilized fast-neutron mutagenized population of Jao Hom Nin (JHN) - a popular purple rice cultivar - we microscopically examined hundreds of flag leaves to identify four stomatal model mutants with either high density (HD) or low density (LD) stomata, and small-sized (SS) or large-sized (LS) stomata. With similar genetic background and uniformity, the stomatal model mutants were used to understand the role of stomatal variants on physiological responses to abiotic stress. Our results show that SS and HD respond better to increasing CO2 concentration and HD has higher stomatal conductance (gs) compared to the other stomatal model mutants, although the effects on gas exchange or overall plant performance were small under greenhouse conditions. In addition, the results of our drought experiments suggest that LD and SS can better adapt to restricted water conditions, and LD showed higher water use efficiency (WUE) and biomass/plant than other stomatal model mutants under long-term restricted water treatment. Finally, our study suggests that reducing stomata density and size may play a promising role for further work on developing a climate-ready rice variety to adapt to drought and heat stress. We propose that low stomata density and small size have high potential as genetic donors for improving WUE in climate-ready rice.

Objective: Mechanisms of insulin resistance in polycystic ovary syndrome (PCOS) remain ill defined, contributing to sub-optimal therapies. Recognising skeletal muscle plays a key role in glucose homeostasis we investigated early insulin signalling, its association with aberrant transforming growth factor β (TGFβ)-regulated tissue fibrosis. We also explored the impact of aerobic exercise on these molecular pathways. Methods: A secondary analysis from a cross-sectional study was undertaken in women with (n = 30) or without (n = 29) PCOS across lean and overweight BMIs. A subset of participants with (n = 8) or without (n = 8) PCOS who were overweight completed 12 weeks of aerobic exercise training. Muscle was sampled before a nd 30 min into a euglycaemic-hyperinsulinaemic clamp pre and post training. Results: We found reduced signalling in PCOS of mechanistic target of r apamycin (mTOR). Exercise training augmented but did not completely rescue this signalling defect in women with PCOS. Genes in the TGFβ signalling network were upregulated in skeletal muscle in the overweight women with PCOS but were unresponsive to exercise training except for genes encoding LOX, collagen 1 and 3. Conclusions: We provide new insights into defects in early insulin signalli ng, tissue fibrosis, and hyperandrogenism in PCOS-specific insulin resistance in lean and overweight women. PCOS-specific insulin signalling defects were isolated to mTOR, while gene expression implicated TGFβ ligand regulating a fibrosis in the PCOS-obesity synergy in ins ulin resistance and altered responses to exercise. Interestingly, th ere was little evidence for hyperandrogenism as a mechanism for insulin resistance.