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Abstract Background Antenatal steroid therapy for fetal lung maturation is routinely administered to women at risk of preterm delivery. There is strong evidence to demonstrate benefit from antenatal steroids in terms of survival and respiratory disease, notably in infants delivered at or below 32 weeks’ gestation. However, dosing remains unoptimized and lung benefits are highly variable. Current treatment regimens generate high-concentration, pulsatile fetal steroid exposures now associated with increased risk of childhood neurodevelopmental diseases. We hypothesized that damage-associated changes in the fetal hippocampal transcriptome would be independent of preterm lung function. Methods Date-mated ewes carrying a single fetus at 122 ± 2dGA (term = 150dGA) were randomized into 4 groups: (i) Saline Control Group, 4×2ml maternal saline intramuscular(IM) injections at 12hr intervals (n = 11); or (ii) Dex High Group, 2×12mg maternal IM dexamethasone phosphate injections at 12hr intervals followed by 2×2ml IM saline injections at 12hr intervals (n = 12; representing a clinical regimen used in Singapore); or (iii) Dex Low Group, 4×1.5mg maternal IM dexamethasone phosphate injections 12hr intervals (n = 12); or (iv) Beta-Acetate Group, 1×0.125mg/kg maternal IM betamethasone acetate injection followed by 3×2ml IM sterile normal saline injections 12hr intervals (n = 8). Lambs were surgically delivered 48hr after first maternal injection at 122–125dGA, ventilated for 30min to establish lung function, and euthanised for necropsy and tissue collection. Results Preterm lambs from the Dex Low and Beta-Acetate Groups had statistically and biologically significant lung function improvements (measured by gas exchange, lung compliance). Compared to the Saline Control Group, hippocampal transcriptomic data identified 879 differentially significant expressed genes (at least 1.5-fold change and FDR

Precision Livestock Farming (PLF) is a mechanism that manages a production system. This mechanism includes mathematical models and controllable inputs that can predict inputs with processes and results that can be monitored periodically. These parameters of PLF systems can improve resource use efficiency and reduce cultivation costs. Many situations, such as the behaviour of animals on farms, their nutrition, estrus cycles, and epidemics, can be monitored with wearable devices containing various sensors. However, real-time monitoring of the data collected by these devices is possible with Internet of Things (IoT) technology. IoT is a multi-layered network that enables sensors within the system to communicate with each other and implement certain decisions when necessary. Sensors and IoT devices extract information from the raw data they collect from the environment, which is then shared with other objects, devices, or servers via the internet. The real-time data collection, processing, and analysis provided by IoT enables improvements in the management of animal farms. This systematic review addresses IoT concepts and applications in the livestock sector from a systematic perspective for different animal farms.

Abstract Introduction This paper outlines the design, implementation, and usability study results of the patient empowerment process for chronic disease management, using Patient Reported Outcome Measurements and Shared Decision-Making Processes. Background The ADLIFE project aims to develop innovative, digital health solutions to support personalized, integrated care for patients with severe long-term conditions such as Chronic Obstructive Pulmonary Disease, and/or Chronic Heart Failure. Successful long-term management of patients with chronic conditions requires active patient self-management and a proactive involvement of patients in their healthcare and treatment. This calls for a patient-provider partnership within an integrated system of collaborative care, supporting self-management, shared-decision making, collection of patient reported outcome measures, education, and follow-up. Methods ADLIFE follows an outcome-based and patient-centered approach where PROMs represent an especially valuable tool to evaluate the outcomes of the care delivered. We have selected 11 standardized PROMs for evaluating the most recent patients’ clinical context, enabling the decision-making process, and personalized care planning. The ADLIFE project implements the "SHARE approach’ for enabling shared decision-making via two digital platforms for healthcare professionals and patients. We have successfully integrated PROMs and shared decision-making processes into our digital toolbox, based on an international interoperability standard, namely HL7 FHIR. A usability study was conducted with 3 clinical sites with 20 users in total to gather feedback and to subsequently prioritize updates to the ADLIFE toolbox. Results User satisfaction is measured in the QUIS7 questionnaire on a 9-point scale in the following aspects: overall reaction, screen, terminology and tool feedback, learning, multimedia, training material and system capabilities. With all the average scores above 6 in all categories, most respondents have a positive reaction to the ADLIFE PEP platform and find it easy to use. We have identified shortcomings and have prioritized updates to the platform before clinical pilot studies are initiated. Conclusions Having finalized design, implementation, and pre-deployment usability studies, and updated the tool based on further feedback, our patient empowerment mechanisms enabled via PROMs and shared decision-making processes are ready to be piloted in clinal settings. Clinical studies will be conducted based at six healthcare settings across Spain, UK, Germany, Denmark, and Israel.

Abstract Dams and reservoirs are often needed to provide environmental water and maintain suitable water temperatures for downstream ecosystems. Here, we evaluate if water allocated to the environment, with storage to manage it, might allow environmental water to more reliably meet ecosystem objectives than a proportion of natural flow. We use a priority-based water balance operations model and a reservoir temperature model to evaluate 1) pass-through of a portion of reservoir inflow versus 2) allocating a portion of storage capacity and inflow for downstream flow and stream temperature objectives. We compare trade-offs to other senior and junior priority water demands. In many months, pass-through flows exceed the volumes needed to meet environmental demands. Storage provides the ability to manage release timing to use water efficiently for environmental benefit, with a co-benefit of increasing reservoir storage to protect cold-water at depth in the reservoir.

In STEMNET's report, 76% of 500 teachers interviewed stated that joining the STEM Club increased students' ability to solve real-world problems. This study aims to develop a valid and reliable measurement tool for evaluating STEM clubs. The research sample consisting of 149 teachers who carry out STEM club activities in schools in Turkey was determined using the purposive sampling method. Content and construct validity and reliability analyses have been performed for this purpose. To ensure content validity, (1) a pool of questions based on the literature was created, (2) draft scale items were determined, (3) an expert was allowed to check them, and (4)item difficulty and discrimination index were calculated. To ensure construct validity, (1) exploratory factor analyses (EFA) and (2) confirmatory factor analyses (CFA) were performed on both the same and different samples. As a result of the analyses, having the same data set be analyzed with different software was sufficient for verifying the factor structure. A three-factor structure consisting of 29 items was obtained, which explains 52% of the variance. Cronbach's alpha of reliability for the overall scale was calculated as 0.92. As a result, a valid and reliable scale was determined to have been developed for researchers and program practitioners to evaluate STEM clubs. Suggestions have been made that the scale can be used on STEM clubs at the provincial, district, and school levels to determine their efficiency and productivity.

This study was conducted to examine in depth the influences of the Covid-19 pandemic on the resource systems of mathematics teachers. This qualitative study is based on the documentational approach to didactics and is a case study conducted with two secondary school mathematics teachers teaching in the 7th grade. The research was limited to the subject of equations and equalities. Reflective analysis was used as a data collection method in this study. The data were obtained from the participating teachers in two stages, pre-pandemic and pandemic periods. Data in the first stage, which included the pre-pandemic period; consisted of the schematic representation of resources system for the face-to-face education period of the equations and equalities subject before the beginning of the online education and the semi-structured interview conducted before the online education of the subject started. The data of the second stage including the pandemic period, were obtained through the schematic representation of resources system prepared by the teacher at the beginning of the online education, and the video and audio recordings of the lessons in which the teacher taught the equations and equalities unit in a certain class with online education during the pandemic period. In the first part of the data analysis, the data obtained from the teachers in the prepandemic period were subjected to content analysis and the resources systems of teachers in face-to-face education was revealed. As a result of the examination of the schematic representation of resources systems prepared by the teachers in this section for the face-to-face education period and the analysis of the interview data, two themes, "General Habits" and "Special for Face-to-Face", were reached. In the second part, the data obtained from the teachers during the pandemic period were subjected to content analysis, and the teacher's resources systems in online education was revealed and two themes were reached: "General Habits" and "Special for Pandemic". When the resources systems of the teachers for the period in face-to-face education was compared with the resources systems for the pandemic period in the third section, the change in the documentation systems of the mathematics teachers during the pandemic was also revealed in detail. The results revealed that the duration of completing the unit has changed during the pandemic period, the variety of sources used did not change, but the type shifted from printed sources to z-book applications and benefited from much more technological tools than face-to-face education.

IntroductionThe European Health Data Space (EHDS) initiative was launched to create a unified framework for health data exchange across Europe. Central to this initiative is the European Electronic Health Record Exchange Format, designed to achieve interoperability of electronic health record data across Europe. Despite these advancements, the readiness of current guidelines and implementations, such as the European Patient Summary, to support secondary use in clinical research, particularly in cardiology, remains underexplored.MethodsThis study aims to evaluate the European Patient Summary guidelines and their implementations, specifically the HL7 FHIR International Patient Summary Implementation Guide, to determine their suitability for secondary use in clinical research. The focus is on identifying gaps and extensions needed to enhance the utility of the European Patient Summary for building artificial intelligence models in assisting heart failure management.ResultsWe selected two European Union-funded research projects, DataTools4Heart and AI4HF, that aim to reuse electronic health record data to develop artificial intelligence models for personalized decision support services for heart failure patients. We analyzed their clinical use cases and the specific data items required, and we compared these with the current European Patient Summary guidelines and provided a detailed gap analysis indicating similarities and required extensions. In our gap analysis, we also compared the needs of DataTools4Heart and AI4HF with the HL7 FHIR International Patient Summary Implementation Guide to assess the extensions needed to support clinical research.DiscussionThe EHDS is a transformative initiative to establish a European health data ecosystem that supports healthcare delivery and clinical research. Our comparative analysis demonstrates that, with minor extensions, these guidelines have significant potential to facilitate access to electronic healthcare record data for the secondary use, particularly in training AI models. We advocate for the adoption of an International Patient Summary format as a semantically interoperable core set of data elements, which will enhance global clinical research efforts and improve patient outcomes through precision medicine.

Radioligand therapies such as [177Lu] Lu-PSMA-617 have gained significant momentum in cancer treatment after clinical trials and multicenter studies demonstrated their safety and efficacy. As these innovative treatments become more widespread, rare and unique clinical manifestations are expected to be observed. In this report, we describe a case with metastatic castration-resistant prostate cancer (mCRPC) and peripancreatic lymph node metastases who developed acute pancreatitis following [177Lu] Lu-PSMA-617 therapy.

PurposeTo develop a deep learning-based method for rapid liver proton-density fat fraction (PDFF) and R2 * quantification with built-in uncertainty estimation using self-gated free-breathing stack-of-radial MRI.MethodsThis work developed an uncertainty-aware physics-driven deep learning network (UP-Net) to (1) suppress radial streaking artifacts because of undersampling after self-gating, (2) calculate accurate quantitative maps, and (3) provide pixel-wise uncertainty maps. UP-Net incorporated a phase augmentation strategy, generative adversarial network architecture, and an MRI physics loss term based on a fat-water and R2 * signal model. UP-Net was trained and tested using free-breathing multi-echo stack-of-radial MRI data from 105 subjects. UP-Net uncertainty scores were calibrated in a validation dataset and used to predict quantification errors for liver PDFF and R2 * in a testing dataset.ResultsCompared with images reconstructed using compressed sensing (CS), UP-Net achieved structural similarity index >0.87 and normalized root mean squared error

* Context.--Tumoral (grossly visible) intraductal neoplasms of the bile ducts are still being characterized. Objective.--To investigate their morphologic, immunohistochemical, and molecular features. Design.--Forty-one cases were classified as gastric-, intestinal-, pancreatobiliary-type intraductal papillary neoplasm (IPN), intraductal oncocytic papillary neoplasm (IOPN), or intraductal tubulopapillary neoplasm (ITPN) on the basis of histology. All neoplasms were subjected to targeted next-generation sequencing. Results.--The mean age at diagnosis was 69 years (4281 years); male to female ratio was 1.3. Most neoplasms (n = 23, 56%) were extrahepatic/large (mean size, 4.6 cm). The majority (n = 32, 78%) contained high-grade dysplasia, and 68% (n = 28) revealed invasion. All gastric-type IPNs (n = 9) and most ITPNs/IOPNs showed consistent colabeling for CK7/MUC6, which was less common among others (P = .004). Intestinal-type IPNs (n = 5) showed higher rates of CK20 expression than others (P < .001). Overall, the most commonly mutated genes included TP53 and APC, while copy number variants affected ELF3 and CDKN2A/B. All gastric-type IPNs contained an alteration affecting the Wnt signaling pathway; 7 of 9 (78%) showed aberrations in the MAPK pathway. Mutations in APC and KRAS were common in gastric-type IPNs as compared with others (P = .01 for both). SMAD4 was more frequently mutated in intestinaltype IPNs (P = .02). Pancreatobiliary-type IPNs (n = 14) exhibited frequent alterations in tumor suppressor genes including TP53, CDKN2A/B, and ARID2 (P = .04, P = .01 and P = .002, respectively). Of 6 IOPNs analyzed, 3 (50%) revealed ATP1B1-PRKACB fusion. ITPNs (n = 6) showed relatively few recurrent genetic aberrations. Follow-up information was available for 38 patients (median, 58.5 months). The ratio of disease-related deaths was higher for the cases with invasion (56% versus 10%). Conclusions.--Tumoral intraductal neoplasms of the bile ducts, similar to their counterparts in the pancreas, are morphologically and genetically heterogeneous. (Arch Pathol Lab Med. 2023;147:1390-1401; doi: 10.5858/arpa.2022-0343-OA), Tumoral (grossly visible) intraductal neoplasms of the bile ducts are rare tumors, which exhibit variable histomorphology and behavior. The nomenclature for these biliary neoplasms has been inconsistent, and they have [...]