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Abstract Background The purpose of this qualitative study was to identify emergent rehabilitation innovations and clinician perceptions influencing their implementation and outcomes related to hospital discharge decision-making during the Coronavirus 2019 pandemic. Methods Rehabilitation clinicians were recruited from the Veterans Affairs Health Care System and participated in individual semi-structured interviews guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Data were analyzed using a rapid qualitative, deductive team-based approach informed by directed content analysis. Results Twenty-three rehabilitation clinicians representing physical (N = 11) and occupational therapy (N = 12) participated in the study. Three primary themes were generated: (1) Innovation: emerging innovations in discharge processes included perceived increases in team collaboration, shifts in caseload prioritization, and alternative options for post-acute care. (2) Recipients: innovations emerged as approaches to communicating discharge recommendations changed (in-person to virtual) and strong patient/family preferences to discharge to the home challenged collaborative goal setting; and (3) Context: the ability of rehabilitation clinicians to innovate and the form of innovations were influenced by the broader hospital system, interdisciplinary team dynamics, and policy fluctuations. Innovations described by participants included (1) use of technological modalities for interdisciplinary collaboration, (2) expansion of telehealth modalities to deliver care in the home, (3) changes in acute care case prioritization, and (4) alternative options for discharge directly to home. Conclusions Our findings reinforce that rehabilitation clinicians developed innovative strategies to quickly adapt to multiple systems-level factors that were changing in the face of the COVID-19 pandemic. Future research is needed to assess the impact of innovations, remediate unintended consequences, and evaluate the implementation of promising innovations to respond to emerging healthcare delivery needs more rapidly.

Diagnostic uncertainty is prevalent throughout medicine and significantly impacts patient care, especially when it goes unrecognized. However, we lack a reliable clinical means of identifying uncertainty. This study evaluates the narrative discourse within clinical notes in the Electronic Health Record as a means of identifying diagnostic uncertainty. Recognizing that discourse producers use language "semi-automatically" (Partington et al. 2013), we hypothesized that clinicians include distinct indications of uncertainty in their written assessments, which could be elucidated by linguistic analysis. Using a cohort of patients prospectively identified as having an uncertain diagnosis (UD), we conducted a detailed corpus-assisted discourse analysis. The analysis revealed a set of linguistic indicators constitutive of diagnostic uncertainty including terms of modality, register-specific terms, and linguistically identifiable clinical behaviours. This dictionary of UD indicators was thoroughly tested, and its performance was compared with a matched-control dataset. Based on the findings, we built a machine learning classification algorithm with the ability to predict UD patient cohorts with 87.0% accuracy, effectively demonstrating the feasibility of using clinical discourse to classify patients and directly impact the clinical environment.

Suicide has been identified as the second leading cause of death among adolescents in the USA. Although neighborhood violence has also been identified as a major public health issue, few studies have examined the association between exposure to neighborhood violence and suicidal behaviors among adolescents using a large nationally representative sample. Guided by the Interpersonal Theory of Suicide, this study examined the cross-sectional association between exposure to neighborhood violence and suicidal behaviors among adolescents. Data for this study came from the 2021 Adolescent Behaviors and Experiences Survey (n = 7663, 52.1% Female). The outcome variables investigated in this study were suicidal ideation and suicide attempts, and the main explanatory variable was exposure to neighborhood violence. Data were analyzed using sequential hierarchical binary logistic regression. Of the 7663 adolescents examined, 20.1% experienced suicidal ideation and 8.9% attempted suicide at least once during the past 12 months. About 21% of the adolescents reported being exposed to neighborhood violence. Controlling for other factors, we found that exposure to neighborhood violence was associated with 1.38 times higher odds of making suicide attempts (AOR = 1.38, p = 0.029, 95% CI 1.04-1.84). The findings of this study could inform clinicians, practitioners, and school counselors on how to identify adolescents who may be particularly at risk of suicide attempts and focus efforts on prevention.

Reflecting recent advances in our understanding of soil organic carbon (SOC) turnover and persistence, a new generation of models increasingly makes the distinction between the more labile soil particulate organic matter (POM) and the more persistent mineral-associated organic matter (MAOM). Unlike the typically poorly defined conceptual pools of traditional SOC models, the POM and MAOM soil fractions can be directly measured for their carbon content and isotopic composition, allowing for fraction-specific data assimilation. However, the new-generation model predictions of POM and MAOM dynamics have not yet been validated with fraction-specific carbon and 14C observations. In this study, we evaluate five influential and actively developed new-generation models (CORPSE, MEND, Millennial, MIMICS, SOMic) with fraction-specific and bulk soil 14C measurements of 77 mineral topsoil profiles in the International Soil Radiocarbon Database (ISRaD). We find that all five models consistently overestimate the 14C content (Δ14C) of POM by 69 ‰ on average, and two out of the five models also strongly overestimate the Δ14C of MAOM by more than 80 ‰ on average, indicating that the models generally overestimate the turnover rates of SOC and do not adequately represent the long-term stabilization of carbon in soils. These results call for more widespread usage of fraction-specific carbon and 14C measurements for parameter calibration and may even suggest that some new-generation models might need to restructure or further subdivide their simulated carbon pools in order to accurately reproduce SOC dynamics.

Coral reefs are being degraded at alarming rates and decisive intervention actions are urgently needed. One such intervention is coral cryopreservation. Although the cryopreservation of coral sperm and larvae has been achieved, preservation of coral fragments including both its tissue and skeleton, has not. The overarching aim of this study was to understand and assess the physiological stressors that might underlie coral fragment cryopreservation, understand the long-term consequences of these exposures to continued growth, and develop a health metrics scale for future research. Therefore, we assessed small fragments (~1 cm2) from the Hawaiian coral, Porites compressa, examining: (1) chill sensitivity; (2) chemical sensitivity to complex cryoprotectants; (3) methods to safely remove algal symbionts of coral for cryopreservation; (4) continued growth over time of coral fragments exposed to chilling and cryoprotectants; and (5) assessment of health and viability of coral fragments post the applied treatments. Corals were able to withstand chilling to 0 °C for 1 min and after 2 weeks were not significantly different from the live controls, whereas, corals exposed to complex cryoprotectants needed 3 weeks of recovery. Most importantly, it appears that once the coral fragments had surpassed this initial recovery, there was no difference in subsequent growth. Technological advances in cryo-technology promise to support successful coral fragment cryopreservation soon, and its success could help secure much of the genetic and biodiversity of reefs in the next decade.

Introduction The COVID-19 pandemic had devastating health and socioeconomic effects, partly due to policy decisions to mitigate them. Little evidence exists of approaches that guided decisions in settings with limited pre-pandemic modelling capacity. We thus sought to identify knowledge translation mechanisms, enabling factors and structures needed to effectively translate modelled evidence into policy decisions.Methods We used convergent mixed methods in a participatory action approach, with quantitative data from a survey and qualitative data from a scoping review, in-depth interviews and workshop notes. Participants included researchers and policy actors involved in COVID-19 evidence generation and decision-making. They were mostly from lower- and middle-income countries (LMICs) in Africa, Southeast Asia and Latin America. Quantitative and qualitative data integration occurred during data analysis through triangulation and during reporting in a narrative synthesis.Results We engaged 147 researchers and 57 policy actors from 28 countries. We found that the strategies required to use modelled evidence effectively include capacity building of modelling expertise and communication, improved data infrastructure, sustained funding and dedicated knowledge translation platforms. The common knowledge translation mechanisms used during the pandemic included policy briefs, face-to-face debriefings and dashboards. Some enabling factors for knowledge translation comprised solid relationships and open communication between researchers and policymakers, credibility of researchers, co-production of policy questions and embedding researchers in policymaking spaces. Barriers included competition among modellers, negative attitude of policymakers towards research, political influences and demand for quick outputs.Conclusion We provide a contextualised understanding of knowledge translation for LMICs during the COVID-19 pandemic. Furthermore, we share key lessons on how knowledge translation from mathematical modelling complements the broader learning agenda related to pandemic preparedness and long-term investments in evidence-to-policy translation. Our findings led to the co-development of a knowledge translation framework useful in various settings to guide decision-making, especially for public health emergencies.

Abstract Understanding the temporal dynamics of soil microbial biomass is crucial for assessing soil ecosystem functions and services, yet these dynamics are globally uncertain. Here, we compiled a data set of soil microbial biomass carbon (MBC) and nitrogen (MBN) from 1493 studies between 1988 and 2019 to elucidate their temporal trends and potential drivers. Results showed that global MBC and MBN significantly decreased by 0.033 Mg C ha−1 yr−1 and 0.007 Mg N ha−1 yr−1 at 0–30 cm soil depth, between 1988 and 2019, respectively, which might be primarily attributed to the warming of the climate, the increase in global precipitation, and reduction of soil organic carbon (SOC) stock. The rate of decline in MBC and MBN showed a non‐linear trend: following a decline from 1988 to 1999, it slowed down until 2014, likely due to the global warming hiatus. Afterward, the pace of decline increased again from 2015 to 2019. Boreal biomes experienced the largest decrease in soil microbial biomass with the reduction rate of MBC being 4.3 times higher than in temperate biomes, showing a higher sensitivity in boreal biomes to climate change. Grassland ecosystems also exhibited greater reductions, possibly driven by their degradation. These findings shed valuable insights on the long‐term dynamics of soil microbial biomass on a global scale over the last three decades. Furthermore, this study underscores the importance of preserving soil microbial biomass as a key strategy to mitigate the adverse effects of future climate change, thereby sustaining ecosystem health and resilience.

Introduction There is a growing emphasis on improving primary healthcare (PHC) services and granting frontline service providers more decision-making autonomy. In October 2023, Kenya enacted legislation mandating nationwide facility autonomy. There is limited understanding of the effects of health facility autonomy on PHC facilities performance. It is recognised that stakeholder interests influence reforms, and gender plays a critical role in access to health and its outcomes. This protocol outlines the methods for a study that plans to evaluate the effects, implementation experience, political economy and gendered effects of health facility autonomy reforms in Kenya.Methods and analysis The research will use a before-and-after quasi-experimental study design to measure the effects of the reform on service readiness and service utilisation and a cross-sectional qualitative study to explore the implementation experience, political economy and gendered effects of these reforms. Data to measure the effects of autonomy will be collected from a sample of 80 health facilities and 1600 clients per study arm. Qualitative interviews will involve approximately 83 facility managers and policymakers at the county level, distributed across intervening (36) and planning to intervene (36) counties. Additionally, 11 interviews will be conducted at the national level with representatives from the Ministry of Health, the National Treasury, the Controller of Budget, the Council of Governors, the Auditor General and development partners. Given the uncertainty surrounding the implementation of the reforms, this study proposes two secondary designs in the event our primary design is not feasible—a cross-sectional study and a quasi-experimental interrupted time series design. The study will use a difference-in-difference analysis for the quantitative component to evaluate the effects of the reforms, while using thematic analysis for the qualitative component to evaluate the political economy and the implementation experience of the reforms.Ethics and dissemination This study was approved by the Kenya Medical Research Institute Scientific and Ethics Review Unit (KEMRI/SERU/CGMR-C/294/4708) and the National Commission for Science, Technology and Innovation (NACOSTI/P/23/28111). We plan to disseminate the findings through publications, policy briefs and dissemination workshops.

Abstract Objectives To clarify the mechanisms of interventions addressing loneliness and social isolation in older adults living in nursing homes through the involvement of primary and secondary informal caregivers. Methods This scoping review was performed by two independent reviewers, covering the period between 2011 and 2022 and the databases MEDLINE, CINAHL, PsycINFO and Scopus. It included terms related to (A) informal caregivers, (B) nursing homes, (C) psychosocial interventions, (D) involvement and (E) social isolation or loneliness. Results Thirty-three studies met the inclusion criteria. Although there were various definitions and assessment tools related to social isolation and loneliness, the studies referred to three dimensions of these concepts in nursing home residents: the quantity of social interactions, the perception of these encounters and biographical changes in social relationships. Most studies did not explicate the mechanisms of these interventions. The review uncovered the following aspects of intervention mechanisms: increasing opportunities for social contact, creating meaningful encounters, maintaining existing relationships with primary informal caregivers and establishing new ones with secondary informal caregivers. Conclusion Studies reporting on interventions addressing loneliness and social isolation in nursing home residents need to clarify and detail their intervention mechanisms in order to foster more targeted interventions. In addition, there is a need for further research on large-scale programs or care philosophies in this field and the development of intervention designs, which allow for tailored intervention formats in order to respond to the individual perception of social relationships.

Abstract Background Use of participatory research methods is increasing in research trials. Once partnerships are established with end-users, there is less guidance about processes research teams can use to successfully incorporate end-user feedback. The current study describes the use of a brief reflections process to systematically examine and evaluate the impact of end-user feedback on study conduct. Methods The Comparative Effectiveness of Trauma-Focused and Non-Trauma- Focused Treatment Strategies for PTSD among those with Co-Occurring SUD (COMPASS) study was a randomized controlled trial to determine the effectiveness of trauma-focused psychotherapy versus non-trauma-focused psychotherapy for Veterans with co-occurring posttraumatic stress disorder and substance use disorder who were entering substance use treatment within the Department of Veterans Affairs. We developed and paired a process of “brief reflections” with our end-user engagement methods as part of a supplemental evaluation of the COMPASS study engagement plan. Brief reflections were 30-minute semi-structured discussions with the COMPASS Team following meetings with three study engagement panels about feedback received regarding study issues. To evaluate the impact of panel feedback, 16 reflections were audio-recorded, transcribed, rapidly analyzed, and integrated with other study data sources. Results Brief reflections revealed that the engagement panels made recommended changes in eight areas: enhancing recruitment; study assessment completion; creating uniformity across Study Coordinators; building Study Coordinator connection to Veteran participants; mismatch between study procedures and clinical practice; therapist skill with patients with active substance use; therapist burnout; and dissemination of study findings. Some recommendations positively impact study conduct while others had mixed impact. Reflections were iterative and led to emergent processes that included revisiting previously discussed topics, cross-pollination of ideas across panels, and sparking solutions amongst the Team when the panels did not make any recommendations or recommendations were not feasible. Conclusions When paired with end-user engagement methods, brief reflections can facilitate systematic examination of end-user input, particularly when the engagement strategy is robust. Reflections offer a forum of accountability for researchers to give careful thought to end-user recommendations and make timely improvements to the study conduct. Reflections can also facilitate evaluation of these recommendations and reveal end-user-driven strategies that can effectively improve study conduct. Trial registration ClinicalTrials.gov (NCT04581434) on October 9, 2020; https://clinicaltrials.gov/ct2/show/study/NCT04581434?term=NCT04581434&draw=2&rank=1 .

Dawood Sayed,1 Timothy R Deer,2,3 Vinicius Tieppo Francio,1 Christopher M Lam,1 Kamil Sochacki,4 Nasir Hussain,5 Tristan E Weaver,5 Jay Karri,6,7 Vwaire Orhurhu,8,9 Natalie Holmes Strand,10 Jacqueline Soicher Weisbein,11 Jonathan M Hagedorn,12 Ryan S D’Souza,12 Ryan R Budwany,2 Ahish Chitneni,13 Kasra Amirdelfan,14 Michael J Dorsi,15 Dan TD Nguyen,16 Christopher Bovinet,17 Alaa Abd-Elsayed18 1Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA; 2Pain Services, Spine and Nerve Center of the Virginias, Charleston, WV, USA; 3Anesthesiology and Pain Medicine, West Virginia University School of Medicine, Charleston, WV, USA; 4Department of Anesthesiology and Perioperative Medicine, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA; 5Anesthesiology, the Ohio State University Wexner Medical Center, Columbus, OH, USA; 6Department of Orthopedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; 7Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA; 8Department of Anesthesiology, University of Pittsburgh Medical Center, Williamsport, PA, USA; 9Pain Medicine, MVM Health, East Stroudsburg, PA, USA; 10Anesthesiology and Pain Medicine, Mayo Clinic, Phoenix, AZ, USA; 11Interventional Pain Management, Napa Valley Orthopaedic Medical Group, Napa, CA, USA; 12Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; 13Department of Rehabilitation & Regenerative Medicine, New York Presbyterian – Columbia & Cornell, New York, NY, USA; 14Director of Clinical Research, Boomerang Healthcare, Walnut Creek, CA, USA; 15Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA; 16Neuroradiology & Pain Solutions of Oklahoma, Edmond, OK, USA; 17The Spine Center of SE Georgia, Brunswick, GA, USA; 18Anesthesiology, University of Wisconsin, Madison, WI, USACorrespondence: Dawood Sayed, Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA, Tel +1 785-550-5800, Email dsayed@kumc.eduAbstract: Clinical management of sacroiliac disease has proven challenging from both diagnostic and therapeutic perspectives. Although it is widely regarded as a common source of low back pain, little consensus exists on the appropriate clinical management of sacroiliac joint pain and dysfunction. Understanding the biomechanics, innervation, and function of this complex load bearing joint is critical to formulating appropriate treatment algorithms for SI joint disorders. ASPN has developed this comprehensive practice guideline to serve as a foundational reference on the appropriate management of SI joint disorders utilizing the best available evidence and serve as a foundational guide for the treatment of adult patients in the United States and globally.Keywords: sacroiliac joint, sacroiliitis, chronic pain, best practices, radiofrequency ablation, sacroiliac joint fusion

Abstract Background Hospitalizations involving opioid use disorder (OUD) are increasing. Medications for opioid use disorder (MOUD) reduce mortality and acute care utilization. Hospitalization is a reachable moment for initiating MOUD and arranging for ongoing MOUD engagement following hospital discharge. Despite existing quality metrics for MOUD initiation and engagement, few hospitals provide hospital based opioid treatment (HBOT). This protocol describes a cluster-randomized hybrid type-2 implementation study comparing low-intensity and high-intensity implementation support strategies to help community hospitals implement HBOT. Methods Four state implementation hubs with expertise in initiating HBOT programs will provide implementation support to 24 community hospitals (6 hospitals/hub) interested in starting HBOT. Community hospitals will be randomized to 24-months of either a low-intensity intervention (distribution of an HBOT best-practice manual, a lecture series based on the manual, referral to publicly available resources, and on-demand technical assistance) or a high-intensity intervention (the low-intensity intervention plus funding for a hospital HBOT champion and regular practice facilitation sessions with an expert hub). The primary efficacy outcome, adapted from the National Committee on Quality Assurance, is the proportion of patients engaged in MOUD 34-days following hospital discharge. Secondary and exploratory outcomes include acute care utilization, non-fatal overdose, death, MOUD engagement at various time points, hospital length of stay, and discharges against medical advice. Primary, secondary, and exploratory outcomes will be derived from state Medicaid data. Implementation outcomes, barriers, and facilitators are assessed via longitudinal surveys, qualitative interviews, practice facilitation contact logs, and HBOT sustainability metrics. We hypothesize that the proportion of patients receiving care at hospitals randomized to the high-intensity arm will have greater MOUD engagement following hospital discharge. Discussion Initiation of MOUD during hospitalization improves MOUD engagement post hospitalization. Few studies, however, have tested different implementation strategies on HBOT uptake, outcome, and sustainability and only one to date has tested implementation of a specific type of HBOT (addiction consultation services). This cluster-randomized study comparing different intensities of HBOT implementation support will inform hospitals and policymakers in identifying effective strategies for promoting HBOT dissemination and adoption in community hospitals. Trial registration NCT04921787.

Dawood Sayed,1 Timothy Ray Deer,2 Jonathan M Hagedorn,3 Asim Sayed,4 Ryan S D’Souza,3 Christopher M Lam,1 Nasir Khatri,5 Zohra Hussaini,1 Scott G Pritzlaff,6 Newaj Mohammad Abdullah,7 Vinicius Tieppo Francio,1 Steven Michael Falowski,8 Yussr M Ibrahim,9 Mark N Malinowski,10 Ryan R Budwany,2 Natalie Holmes Strand,11 Kamil M Sochacki,12 Anuj Shah,13 Tyler M Dunn,11 Morad Nasseri,14 David W Lee,15 Leonardo Kapural,16 Marshall David Bedder,17,18 Erika A Petersen,19 Kasra Amirdelfan,20 Michael E Schatman,21,22 Jay Samuel Grider23 1Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA; 2Pain Services, Spine and Nerve Center of the Virginias, Charleston, WV, USA; 3Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; 4Podiatry/Surgery, Susan B. Allen Memorial Hospital, El Dorado, KS, USA; 5Interventional Pain Medicine, Novant Spine Specialists, Charlotte, NC, USA; 6Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA, USA; 7Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA; 8Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA; 9Pain Medicine, Northern Light Eastern Maine Medical Center, Bangor, ME, USA; 10OhioHealth Neurological Physicians, OhioHealth, Columbus, OH, USA; 11Anesthesiology and Pain Medicine, Mayo Clinic, Phoenix, AZ, USA; 12Department of Anesthesiology and Perioperative Medicine, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA; 13Department of Physical Medicine and Rehabilitation, Detroit Medical Center, Detroit, MI, USA; 14Interventional Pain Medicine / Neurology, Boomerang Healthcare, Walnut Creek, CA, USA; 15Pain Management Specialist, Fullerton Orthopedic, Fullerton, CA, USA; 16Carolinas Pain Institute, Winston Salem, NC, USA; 17Chief of Pain Medicine Service, Augusta VAMC, Augusta, GA, USA; 18Associate Professor and Director, Addiction Medicine Fellowship Program, Department Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA; 19Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 20Director of Clinical Research, Boomerang Healthcare, Walnut Creek, CA, USA; 21Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 22Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA; 23Anesthesiology, Division of Pain Medicine, University of Kentucky College of Medicine, Lexington, KY, USACorrespondence: Dawood Sayed, Anesthesiology and Pain Medicine, the University of Kansas Medical Center, Kansas City, KS, USA, Tel +1 785-550-5800, Email dsayed@kumc.eduIntroduction: Painful diabetic neuropathy (PDN) is a leading cause of pain and disability globally with a lack of consensus on the appropriate treatment of those suffering from this condition. Recent advancements in both pharmacotherapy and interventional approaches have broadened the treatment options for PDN. There exists a need for a comprehensive guideline for the safe and effective treatment of patients suffering from PDN.Objective: The SWEET Guideline was developed to provide clinicians with the most comprehensive guideline for the safe and appropriate treatment of patients suffering from PDN.Methods: The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations for PDN. A multidisciplinary group of international experts developed the SWEET guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Meeting Abstracts, and Scopus to identify and compile the evidence for diabetic neuropathy pain treatments (per section as listed in the manuscript) for the treatment of pain. Manuscripts from 2000-present were included in the search process.Results: After a comprehensive review and analysis of the available evidence, the ASPN SWEET guideline was able to rate the literature and provide therapy grades for most available treatments for PDN utilizing the United States Preventive Services Task Force criteria.Conclusion: The ASPN SWEET Guideline represents the most comprehensive review of the available treatments for PDN and their appropriate and safe utilization.Keywords: diabetes, painful diabetic neuropathy, neuropathy, spinal cord stimulation, chronic pain, diabetic neuropathy

Background:. This study examines the rheological properties of various dermal fillers, including hyaluronic acid (HA) fillers, poly-L-lactic acid (PLLA), and calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) gels, with a particular focus on the impact of aqueous dilution on CaHA-CMC’s rheology and potential clinical implications. Methods:. Using standardized rheological analysis, we measured and compared the elastic modulus (G′), viscous modulus (G″), and the tan δ values of different dilutions of CaHA-CMC against published values of HA and PLLA fillers. The study aimed to determine the potential clinical use of application-specific CaHA-CMC hydrogel dilutions along a range of gel strength and cohesion for hydrogel fillers in current use. Results:. The findings demonstrate that CaHA-CMC’s rheological properties can be tailored across a broad spectrum of viscoelastic parameters through titrated dilution, ranging from high elasticity to low cohesion. Varying the aqueous volume allows for the rheomodulation of CaHA-CMC, potentially matching the entire rheological spectrum of HA fillers and suggesting an expanded range of clinical applications. Conclusions:. The versatility of CaHA-CMC through dilution may offer a customizable approach for clinical applications, providing practitioners with the ability to fine-tune the properties of fillers to meet specific patient needs and treatment goals. This study lays the groundwork for the potential future use of filler dilutional rheomodulation in clinical practice, tailored to patient- and application-specific needs.

In autumn 2022, the District Court of Flensburg justified the criminal trespassing of a climate activist under Section 34 German Criminal Code (necessity as justification). How can such a "climate necessity defence" be legally justified? The court's assessment calls for a special legal and legal-theoretical analysis. The legal interest in "Climate Protection" – derived from the Climate Order of the Federal Constitutional Court of Germany and Article 20a of the Basic Law – is accorded particularly high value at several key points of the ruling. What is impressive here is that the court's reasoning is suitable for justifying a permanent state of climate necessity. In addition, the AG argued a novel standard for the suitability of the act of necessity, referred to in the judgement as "immediate interdependence". The weighing of interests regarding the adequacy of the act of necessity also shows a (new) interesting assessment regarding the priority of state measures to avert danger. These considerations are scrutinised with regard to German law. Subsequently, the legal theory of civil disobedience is used to outline parallel considerations. The court explicitly stated that it was not concerned with civil disobedience because the activism could not be qualified as such. Does this judgement hold water? In fact, the court's reasoning opens the very same field of tensions between legality and legitimacy that classical liberal theories of civil disobedience seek to explore. However, in a certain parallelism to the legal assessment, these too fail to satisfactorily grasp the peculiarities of the climate activism at hand. In any case, this paper seeks to present some of the overall weaknesses in statutory law and legal theory in adapting to the global climate crisis on a national level.

ContextBulk mineral waste materials such as construction and demolition waste are Germany’s largest waste stream. Despite the availability of high-quality recycling pathways such as road base layers, waste concrete is predominantly recycled into lower-quality recycling pathways like earthworks or unbound road construction. This is due to low demand for recycled aggregates in road base layers and frost protection layers, especially in public procurement.PurposeThis study assesses the environmental consequences of increasing high-quality recycling of waste concrete in the near future to provide decision support for public procurement in Germany. The focus lies on climate change due to its importance for decision-makers. However, 17 other impact categories were assessed to avoid problem shifting.MethodsLife cycle assessment (LCA) is applied with background data from ecoinvent 3.9.1. Impact assessment was conducted at midpoint level using IPCC 2021 and ReCiPe Midpoint (H). Foreground data were taken from literature and expert interviews. In line with the goal of this LCA, a consequential modeling approach was followed to account for changes in the material flow system. Substitution creates a cascade effect previously omitted in consequential LCA studies, in which lower quality recycling materials replace higher quality recycling materials in their respective utilization pathways.Results and discussionIncreasing the high-quality recycling of waste concrete into road base layers causes a reduction in environmental impacts for all 18 impact categories, as it replaces natural aggregate and avoids backfilling of mixed mineral waste and excavated earth through substitution effects. Transport distances and ferrous metal recovery were identified as hot spots. Sensitivity analyses show that only transport is a significant issue.ConclusionIncreasing the high-quality recycling of waste concrete in Germany is recommended in terms of environmental impacts. Lower-quality recycling is environmentally feasible only in cases where the avoided transport distances for natural aggregates and backfilling are significantly lower than the additional transport distances for high-quality recycling.

To support youth early motivation for college and careers that meet workforce needs, the Texas Legislature in 2013 passed House Bill 5 to adopt a new high school graduation program, which allows students to pursue "endorsements" as they begin 9th grade. Endorsements introduce high-school students to STEM, Business & Industry, Public Services, Arts & Humanities, and Multidisciplinary areas to help them explore specific career pathways. The study was based on analysis of restricted-use Texas longitudinal administrative and transcript data for students enrolled in the academic year of 2015/16. We examined the mapping of Texas 9th graders on endorsements through an equity and inclusion lens associated with student demographic and academic characteristics. The study was guided by the college and career readiness tenets and social equity theories that identify competing goals in Texas educational policies that may produce (or reproduce) persistent socioeconomic differences in student educational transitions.