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A patrolling strategy that defines fare inspection frequencies on a proof-of-payment transportation system is operationally useful to the transit authority when there is a mechanism for its practical implementation. This study addresses the operational implementation of a fare inspection patrolling strategy under an in-station selective inspection policy using an unpredictable patrolling schedule, where the transit authority select a patrolling schedule each day with some probability. The challenge is to determine the set of patrolling schedules and their respective probabilities of being selected whose systematic day-to-day application matches the inspection frequencies that inhibit the action of opportunistic passengers in the medium term. A Stackelberg game approach is used to represent the hierarchical decision making process between the transit authority and opportunistic passengers. The heterogeneity of opportunistic passengers' decisions to evade fare payment is taken into account. Numerical experiments show that a joint strategy-schedule approach provides good-quality unpredictable patrolling schedules with respect to the optimality gap for large-scale networks. [ABSTRACT FROM AUTHOR]

Demyelinating diseases alter myelin or the coating surrounding most nerve fibers in the central and peripheral nervous systems. The grouping of human central nervous system demyelinating disorders today includes multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) as distinct disease categories. Each disease is caused by a complex combination of genetic and environmental variables, many involving an autoimmune response. Even though these conditions are fundamentally similar, research into genetic factors, their unique clinical manifestations, and lesion pathology has helped with differential diagnosis and disease pathogenesis knowledge. This review aims to synthesize the genetic approaches that explain the differential susceptibility between these diseases, explore the overlapping clinical features, and pathological findings, discuss existing and emerging hypotheses on the etiology of demyelination, and assess recent pathogenicity studies and their implications for human demyelination. This review presents critical information from previous studies on the disease, which asks several questions to understand the gaps in research in this field. [ABSTRACT FROM AUTHOR]

In this study, the impact of pH on the production of ZnO nanostructured thin films using chemical bath deposition was investigated for the purpose of enhancing the efficiency of solar cells. The ZnO films were directly deposited onto glass substrates at various pH levels during the synthesis process. The results indicate that the crystallinity and overall quality of the material were not affected by the pH solution, as observed through X-ray diffraction patterns. However, scanning electron microscopy revealed that surface morphology improved with increasing pH values, leading to changes in the size of the nanoflowers between pH 9 and 11 values. Furthermore, the ZnO nanostructured thin films synthesized at pH levels of 9, 10, and 11 were utilized in the fabrication of dye-sensitized solar cells. The ZnO films synthesized at pH 11 exhibited superior characteristics in short-circuit current density and open-circuit photo-voltage compared with those produced at lower pH values. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the epidemiology and 30-day mortality of adult patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. We retrospectively reviewed the demographic and clinical data of adult patients with S. aureus bloodstream infections (BSI), admitted to a tertiary public teaching medical center in Porto Alegre, Southern Brazil, from January 2014 to December 2019. A total of 928 patients with S. aureus BSI were identified in the study period (68.5 per 100,000 patient-years), and the proportion of MRSA isolates was 22% (19–27%). Thus, 199 patients were included in the analyses. The median age was 62 (IQR: 51–74) years, Charlson Comorbidity Index (CCI) median was 5 (IQR: 3–6), the Pitt bacteremia score (PBS) median was 1 (IQR: 1–4), and the most common site of infection was skin and soft tissue (26%). Most infections were hospital-acquired (54%), empirical anti-MRSA treatment was initiated in 34% of the cases, and in 44% vancomycin minimum inhibitory concentration was 1.5mg/L or above. Sixty-two (31.2%) patients died up to 30 days after the bacteremia episode. Patients with more comorbid conditions (higher CCI; aOR 1.222, p = 0.006) and a more severe presentation (higher PBS; aOR 1.726, p<0.001) were independently associated with mortality. Empiric antimicrobial therapy with an anti-MRSA regimen was associated with reduced mortality (aOR 0.319, p = 0.016). Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI in a population with a high incidence of S. aureus bacteremia. Empiric treatment with an anti-MRSA drug was a protective factor. No significant variation in the incidence of S. aureus BSI was recorded throughout the period. [ABSTRACT FROM AUTHOR]

We report a novel proposal for reducing the digital divide in rural multigrade schools, incorporating knowledge of robotics with a STEM approach to simultaneously promote curricular learning in mathematics and science in several school grades. We used an exploratory qualitative methodology to implement the proposal with 12 multigrade rural students. We explored the contribution of the approaches to the promotion of curricular learning in mathematics and science and the perceptions of using robotics to learn mathematics and science. As data collection techniques, we conducted focus groups and semi-structured interviews with the participants and analyzed their responses thematically. We concluded that the proposal could contribute to meeting the challenges of multigrade teaching. Our findings suggest that the proposal would simultaneously promote the development of curricular learning in mathematics and science in several school grades, offering an alternative for addressing various topics with different degrees of depth. [ABSTRACT FROM AUTHOR]

Background: COVID-19 vaccination rates are lower among historically marginalized populations, including Black/African American and Latinx populations, threatening to contribute to already high COVID-19 morbidity and mortality disparities for these groups. We conducted a community-based participatory research study using qualitative methods to explore knowledge and beliefs about COVID-19 vaccination among Black/African American, Latinx, and Chinese American residents of the San Francisco Bay Area and assess their views on vaccination outreach and delivery strategies. Methods and findings: Data were collected from January 14, 2021, to February 24, 2021, with adult residents (N = 109 [Female: N = 76; 70%]) in San Francisco. Focus groups (N = 10) and in-depth interviews (N = 25) were conducted among Black/African Americans (N = 35), Latinx (N = 40), and Chinese Americans (n = 34) in English, Spanish, Cantonese, or Mandarin. Themes were identified using grounded field theory, and included misinformation, mistrust of government and health institutions, and linguistic and other barriers to vaccine access. All three racial/ethnic groups had experiences with vaccine misinformation and information overload. Many African American and Latinx participants cited structural and interpersonal racism, and anti-immigrant discrimination, as factors reducing their trust in government and public health disseminated information and their willingness to be vaccinated. Participants expressed trust in community-based organizations, including faith-based organizations and community-run clinics. Participants often experienced barriers to vaccine access, such as transportation to drive-in sites, with Latinx and Chinese American groups also frequently citing language barriers. Conclusions: Vaccine outreach strategies must acknowledge how longstanding systemic, institutional, and structural racism contributes to mistrust in government and health institutions and engage with and support trusted messengers from the community to eliminate cultural, linguistic, and other barriers to vaccine access. [ABSTRACT FROM AUTHOR]

SUMMARY: The common‐bean (Phaseolus vulgaris), a widely consumed legume, originated in Mesoamerica and expanded to South America, resulting in the development of two geographically distinct gene pools. Poor soil condition, including metal toxicity, are often constraints to common‐bean crop production. Several P. vulgaris miRNAs, including miR1511, respond to metal toxicity. The MIR1511 gene sequence from the two P. vulgaris model sequenced genotypes revealed that, as opposed to BAT93 (Mesoamerican), the G19833 (Andean) accession displays a 58‐bp deletion, comprising the mature and star miR1511 sequences. Genotyping‐By‐Sequencing data analysis from 87 non‐admixed Phaseolus genotypes, comprising different Phaseolus species and P. vulgaris populations, revealed that all the P. vulgaris Andean genotypes and part of the Mesoamerican (MW1) genotypes analyzed displayed a truncated MIR1511 gene. The geographic origin of genotypes with a complete versus truncated MIR1511 showed a distinct distribution. The P. vulgaris ALS3 (Aluminum Sensitive Protein 3) gene, known to be important for aluminum detoxification in several plants, was experimentally validated as the miR1511 target. Roots from BAT93 plants showed decreased miR1511 and increased ALS3 transcript levels at early stages under aluminum toxicity (AlT), while G19833 plants, lacking mature miR1511, showed higher and earlier ALS3 response. Root architecture analyses evidenced higher tolerance of G19833 plants to AlT. However, G19833 plants engineered for miR1511 overexpression showed lower ALS3 transcript level and increased sensitivity to AlT. Absence of miR1511 in Andean genotypes, resulting in a diminished ALS3 transcript degradation, appears to be an evolutionary advantage to high Al levels in soils with increased drought conditions. Significance Statement: miR1511 is differentially distributed among Phaseolus species and genotypes, and regulates ALS3 transcript, known to be important for aluminum detoxification in plants. The absence of miR1511 in Andean genotypes, resulting in a diminished ALS3 transcript degradation, appears to be an evolutionary advantage to high Al levels in soils with increased drought conditions. [ABSTRACT FROM AUTHOR]

Background: Young female athletes may have higher rates of overuse injuries and sport specialization than male athletes. The association of sports specialization and return to sport (RTS) timeframe is also unknown., Hypothesis: Specialized female athletes will have more intense, year-round training patterns, more overuse injuries, and longer RTS times than male athletes., Study Design: Cohort study., Level of Evidence: Level 3., Methods: Injured athletes aged 10 to 23 years presenting to a sports medicine clinic reported their degree of sport specialization and training patterns. Skeletal maturity was estimated using the Khamis-Roche method. Injury type and RTS timeframes were categorized from electronic medical records. Chi-square tests and logistic regression analysis assessed associations between variables., Results: A total of 485 athletes (40.2% female) were enrolled. Higher degrees of sport specialization were associated strongly with overuse injuries ( P < 0.01). After adjusting for specialization, female athletes were more likely to sustain an overuse injury (adjusted odds ratio, 1.49; P = 0.04). Female athletes participated in fewer total physical activity hours per week ( P < 0.01), fewer free play hours per week ( P < 0.01), and participated in their main sport for more months of the year than their male counterparts ( P = 0.02). Female athletes were more likely to be at a higher developmental stage than male athletes ( P < 0.01). RTS timeframes were increased in athletes with serious overuse injury; however, no association was found between degree of specialization and RTS time regardless of sex., Conclusion: Female athletes are more likely to sustain overuse injuries with more organized, year-round, training and less free play compared with their male counterparts., Clinical Relevance: Female sex may be an independent risk factor of overuse injury. Future strategies to mitigate these risks may include increased free play hours and limiting year-round training through seasonal rest., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Background: Overuse injuries in youth athletes are associated with risks, including sports specialization, biological maturation, female sex, and workload measures. As no assessment tool exists to evaluate risk accumulation, we developed a novel risk factor scoring system (Sport Training Assessment of Risk [STAR]) to assess participants' risk of overuse injury and explore association with return-to-play (RTP) time periods., Hypothesis: (1) STAR will reach an acceptable predictive threshold in the assessment of overuse injury in youth athletes. (2) Higher STAR scores will be associated with increased RTP time periods after injury., Study Design: Longitudinal cohort study., Level of Evidence: Level 3., Methods: Youth athletes with an injury sustained during competitive sport completed questionnaires. Association of questionnaire variables with injury risk type was evaluated via logistic regression analyses, and unweighted and weighted versions of a total risk score were developed. RTP was defined by physician clearance per electronic medical record review. Mantel-Haenszel chi-square tests and Kendall's rank correlation coefficients were used to assess the relationship between weighted total risk score and RTP time periods. The weighted STAR model was analyzed with receiver operating characteristic (ROC) curves., Results: The weighted STAR model trended toward an acceptable level of prediction for overuse (nonserious + serious) injury (area under the ROC curve [AUC], 0.66; 95% CI, 0.61-0.71), but was less predictive for serious overuse injury (AUC, 0.63; 95% CI, 0.55-0.71). Weighted total risk score was weakly associated with return to full play (ρ = 0.11; P < 0.01), and potentially with return to modified play (ρ = -0.08; P = 0.04)., Conclusion: STAR may be a feasible tool for assessing overuse injury risk and RTP time periods in youth athletes but requires further development, as it did not reach an acceptable predictive threshold in this preliminary study., Clinical Relevance: Clinicians can use STAR to assess overuse injury risk in youth athletes., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Background Clonal complex 180 (CC180) is currently the major clone of serotype 3 Streptococcus pneumoniae (Spn). The 13-valent pneumococcal conjugate vaccine (PCV13) does not have significant efficacy against serotype 3 despite polysaccharide inclusion in the vaccine. It was hypothesized that PCV13 may effectively control Clade I of CC180 but that Clades III and IV are resistant, provoking a population shift that enables serotype 3 persistence. This has been observed in the United States, England, and Wales but not Spain. We tested this hypothesis further utilizing a dataset from Portugal. Methods We whole-genome sequenced (WGS) 501 serotype 3 strains from Portugal isolated from patients with pneumococcal infections between 1999-2020. The draft genomes underwent phylogenetic analyses, pangenome profiling, and a genome-wide association study (GWAS). We also completed antibiotic susceptibility testing and compiled over 2,600 serotype 3 multilocus sequence type 180 (MLST180) WGSs to perform global comparative genomics. Findings CC180 Clades I, II, III, IV, and VI distributions were similar when comparing non-invasive pneumonia isolates and invasive disease isolates (Fisher's exact test, P=0.29), and adult and pediatric cases (Fisher's exact test, P=0.074). The serotype 3 CCs shifted post-PCV13 (Fisher's exact test, P<0.0001) and Clade I became dominant. Clade I is largely antibiotic-sensitive and carries the phiOXC141 prophage but the pangenome is heterogenous. Strains from Portugal and Spain, where Clade I remains dominant post-PCV13, have larger pangenomes and are associated with the presence of two genes encoding hypothetical proteins. Interpretation Clade I became dominant in Portugal post-PCV13, despite the burden of the prophage and antibiotic sensitivity. The accessory genome content may mitigate these fitness costs. Regional differences in Clade I prevalence and pangenome heterogeneity suggest that clade dynamics is not a generalizable approach to understanding serotype 3 vaccine escape. Funding National Institute of Child Health and Human Development, Pfizer, and Merck Sharp & Dohme.

Whole genome sequencing (WGS) has become a vital tool in clinical microbiology, playing an important role in outbreak investigations, molecular surveillance, and identification of bacterial species, resistance mechanisms and virulence factors. However, the complexity of WGS data presents challenges in interpretation and reporting, requiring tailored strategies to enhance efficiency and impact. This study explores the diverse needs of key stakeholders in healthcare, including clinical management, laboratory work, public surveillance and epidemiology, infection prevention and control, and academic research, regarding WGS-based reporting of clinically relevant bacterial species. In order to determine preferences regarding WGS reports, human-centered design approach was employed, involving an online survey and a subsequent workshop with stakeholders. The survey gathered responses from 64 participants representing the above mentioned healthcare sectors across geographical regions. Key findings include the identification of barriers related to data accessibility, integration with patient records, and the complexity of interpreting WGS results. As the participants designed their ideal report using nine pre-defined sections of a typical WGS report, differences in needs regarding report structure and content across stakeholders became evident. The workshop discussions further highlighted the need to feature critical findings and quality metrics prominently in reports, as well as the demand for flexible report designs. Commonalities were observed across stakeholder-specific reporting templates, such as the uniform ranking of certain report sections, but preferences regarding the depth of content within these sections varied. Using these findings, we suggest stakeholder-specific structures which should be considered when designing customized reporting templates. In conclusion, this study underscores the importance of tailoring WGS-based reports of clinically relevant bacteria to meet the distinct needs of diverse healthcare stakeholders. The evolving landscape of digital reporting increases the opportunities with respect to WGS reporting and its utility in managing infectious diseases and public health surveillance., Competing Interests: The authors declare that they have no competing interests., (© 2024 Mutschler et al.)

T1 ρ and Quantitative Susceptibility Mapping (QSM) are evolving as substrates for quantifying the progressive nature of knee osteoarthritis., Objective: To evaluate the effects of spin lock time combinations on depth-dependent T1 ρ estimation, in adjunct to QSM, and characterize the degree of shared variance in QSM and T1 ρ for the quantitative measurement of articular cartilage., Design: Twenty healthy participants (10 ​M/10F, 22.2 ​± ​3.4 years) underwent bilateral knee MRI using T1 ρ MAPPS sequences with varying TSLs ([0-120] ms), along with a 3D spoiled gradient echo for QSM. Five total TSL combinations were used for T1 ρ computation, and direct depth-based comparison. Depth-wide variance was assessed in comparison to QSM as a basis to assess for depth-specific variation in T1 ρ computations across healthy cartilage., Results: Longer T1 ρ relaxation times were observed for TSL combinations with higher spin lock times. Depth-specific differences were documented for both QSM and T1 ρ , with most change found at ∼60% depth of the cartilage, relative to the surface. Direct squared linear correlation revealed that most T1 ρ TSL combinations can explain over 30% of the variability in QSM, suggesting inherent shared sensitivity to cartilage microstructure., Conclusions: T1 ρ mapping is subjective to the spin lock time combinations used for computation of relaxation times. When paired with QSM, both similarities and differences in signal sensitivity may be complementary to capture depth-wide changes in articular cartilage., Competing Interests: Dr. Myer consults with commercial entities to support commercialization strategies and applications to the US Food and Drug Administration but has no direct financial interest in the products. Dr. Myer's institution receives current and ongoing grant funding from National Institutes of Health/NIAMS Grants U01AR067997, R01 AR070474, R01AR055563, R01AR076153, R01 AR077248 and industry sponsored research funding related to injury prevention and sport performance to his institution. Dr. Myer receives author royalties from Human Kinetics and Wolters Kluwer. Dr. Myer is an inventor of biofeedback technologies (Patent No: US11350854B2, Augmented and Virtual reality for Sport Performance and Injury Prevention Application, Approval Date: July 06, 2022, Software Copyrighted) designed to enhance rehabilitation and prevent injuries and receives licensing royalties. Dr. Myer and Dr. Diekfuss receive inventor-related royalties resultant from biofeedback technologies (Include Health: LIC1907082014-0706). Dr. Diekfuss also receives author royalties from Kendall Hunt Publishing Company. Dr. Mandava is an employee of GE HealthCare., (© 2024 The Authors.)

Streptococcus dysgalactiae subsp. equisimilis (SDSE) is an emerging cause of human infection with invasive disease incidence and clinical manifestations comparable to the closely related species, Streptococcus pyogenes. Through systematic genomic analyses of 501 disseminated SDSE strains, we demonstrate extensive overlap between the genomes of SDSE and S. pyogenes. More than 75% of core genes are shared between the two species with one third demonstrating evidence of cross-species recombination. Twenty-five percent of mobile genetic element (MGE) clusters and 16 of 55 SDSE MGE insertion regions were shared across species. Assessing potential cross-protection from leading S. pyogenes vaccine candidates on SDSE, 12/34 preclinical vaccine antigen genes were shown to be present in >99% of isolates of both species. Relevant to possible vaccine evasion, six vaccine candidate genes demonstrated evidence of inter-species recombination. These findings demonstrate previously unappreciated levels of genomic overlap between these closely related pathogens with implications for streptococcal pathobiology, disease surveillance and prevention., (© 2024. The Author(s).)

Since autumn 2022, observed numbers of paediatric invasive group A Streptococcus infections in Portugal (n = 89) were higher than in pre-COVID-19 seasons. Between September 2022 and May 2023, the dominant diagnoses were pneumonia (25/79), mostly with empyema (20/25), and sepsis (22/79). A number of cases required admission to intensive care (27/79) and surgery (35/79), and the case fatality rate was 5.1% (4/79). Genomic sequencing (n = 55) revealed multiple genetic lineages, dominated by the M1 UK sublineage (26/55) and more diverse emm 12 isolates (12/55).

The World Health Organization recently began developing a "pandemic treaty" in response to the perceived failures of the global COVID-19 response. The Framework Convention on Tobacco Control, which obligates members to certain global standards in tobacco control, is an example of a global public health agreement that may be used as a model for the pandemic treaty. Several challenges related to the convention, many from the tobacco industry itself, must be addressed if it is to be used as a prototype for a pandemic agreement. These include harm reduction policies, private-sector involvement, and its impact in low- and middle-income countries. A pandemic treaty may encounter similar challenges faced by the Framework Convention on Tobacco Control, particularly from industry groups with financial interests related to infectious disease control and prevention. Addressing challenges at the outset may facilitate the development and implementation of a more robust international instrument.

We report a novel proposal for reducing the digital divide in rural multigrade schools, incorporating knowledge of robotics with a STEM approach to simultaneously promote curricular learning in mathematics and science in several school grades. We used an exploratory qualitative methodology to implement the proposal with 12 multigrade rural students. We explored the contribution of the approaches to the promotion of curricular learning in mathematics and science and the perceptions of using robotics to learn mathematics and science. As data collection techniques, we conducted focus groups and semi-structured interviews with the participants and analyzed their responses thematically. We concluded that the proposal could contribute to meeting the challenges of multigrade teaching. Our findings suggest that the proposal would simultaneously promote the development of curricular learning in mathematics and science in several school grades, offering an alternative for addressing various topics with different degrees of depth.

Background: COVID-19 vaccination rates among U.S. young adults, particularly in communities of color, remain lower than other age groups. We conducted a qualitative, community-based participatory study to explore beliefs and attitudes about COVID-19 vaccines among young adults in Black/African American, Latinx, and Asian American or Pacific Islander (AAPI) communities in the San Francisco Bay Area., Methods: We conducted six focus groups between June and August 2021. Participants were recruited by partnering with community-based organizations in the San Francisco Bay Area. Focus groups included Black/African American ( N =13), Latinx ( N =20), and AAPI ( N =12) participants between 18 and 30 years of age. Emerging themes were identified using a modified Grounded Theory approach., Results: Prominent themes among all three racial-ethnic groups included mistrust in medical and government institutions, strong conviction about self-agency in health decision-making, and exposure to a thicket of contradictory information and misinformation in social media. Social benefit and a sense of familial and societal responsibility were often mentioned as reasons to get vaccinated. Young adult mistrust had a generational flavor fueled by anger about increasing inequity, the profit-orientation of pharmaceutical companies and health institutions, society's failure to rectify injustice, and pessimism about life prospects., Conclusion: Factors influencing vaccine readiness among Black/African American, Latinx, and AAPI young adults have a distinct generational and life-course texture. Outreach efforts should appeal to young adults' interest in family and social responsibility and the social benefits of vaccination, while being cognizant of the friction mandates pose for young adults' sense of self-agency. Efforts will be most effective coming from trusted messengers with a proven commitment to communities of color and health equity., Competing Interests: No competing financial interests exist., (© Francine Rios-Fetchko et al., 2022; Published by Mary Ann Liebert, Inc.)