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Nonlinear transmission lines (NLTLs) provide a means to generate high-repetition-rate, high-power microwaves with fewer auxiliary systems than conventional sources. They are typically driven by pulse forming networks (PFNs) or Marx generators, and one would intuitively hypothesize that the microwave generation would not depend significantly on the method used to generate the input pulse to the NLTL. This study examines the implications on microwave output by using a Blumlein pulse generator with a 10-ns pulse duration and 1.5-ns rise and fall times to drive coaxial NLTLs produced using composites with nickel zinc ferrite and barium strontium titanate (BST) inclusions. Applying a 30-kV pulse to the composite NLTLs produced frequencies ranging from 1.1 to 1.3 GHz with output powers over 20 kW. The output frequencies increased with increasing volume fraction of BST. Measured results and simulations using LT SPICE showed that Blumlein modulators were insufficient to drive NLTLs to produce high-power oscillations; however, LT SPICE simulations showed that applying a standard PFN to the same NLTL produced the expected oscillations. This difference arises because the mechanism for Blumlein pulse formation cancels the shockwaves responsible for inducing microwave production by the NLTL.

Data sharing statement This is an Open Access article under the CC BY 4.0 license The ISARIC4C protocol, data sharing and publication policy are available at https://isaric4c.net. ISARIC4C's Independent Data and Material Access Committee welcomes applications for access to data and materials (https://isaric4c.net). The PHOSP-COVID protocol, consent form, definition and derivation of clinical characteristics and outcomes, training materials, regulatory documents, information about requests for data access, and other relevant study materials are available online: https://phosp.org/resource/. Access to these materials can be granted by contacting phosp@leicester.ac.uk and Phospcontracts@leicester.ac.uk. All data used in this study is available within ODAP and accessible under reasonable request. Data access criteria and information about how to request access is available online: https://phosp.org/resource/. If criteria are met and a request is made, access can be gained by signing the eDRIS user agreement. Supplementary data are available online at https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(22)00584-9/fulltext#supplementaryMaterial . Copyright © 2022 The Author(s). Background: Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced. Methods: In this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia. IgA and IgG responses to NP and S of ancestral SARS-CoV-2, Delta and Omicron (BA.1) variants were measured by electrochemiluminescence and compared with plasma neutralisation data. Findings: Strong and consistent nasal anti-NP and anti-S IgA responses were demonstrated, which remained elevated for nine months (p < 0.0001). Nasal and plasma anti-S IgG remained elevated for at least 12 months (p < 0.0001) with plasma neutralising titres that were raised against all variants compared to controls (p < 0.0001). Of 323 with complete data, 307 were vaccinated between 6 and 12 months; coinciding with rises in nasal and plasma IgA and IgG anti-S titres for all SARS-CoV-2 variants, although the change in nasal IgA was minimal (1.46-fold change after 10 months, p = 0.011) and the median remained below the positive threshold determined by pre-pandemic controls. Samples 12 months after admission showed no association between nasal IgA and plasma IgG anti-S responses (R = 0.05, p = 0.18), indicating that nasal IgA responses are distinct from those in plasma and minimally boosted by vaccination. Interpretation: The decline in nasal IgA responses 9 months after infection and minimal impact of subsequent vaccination may explain the lack of long-lasting nasal defence against reinfection and the limited effects of vaccination on transmission. These findings highlight the need to develop vaccines that enhance nasal immunity. Funding: This study has been supported by ISARIC4C and PHOSP-COVID consortia. ISARIC4C is supported by grants from the National Institute for Health and Care Research and the Medical Research Council. Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research. The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute of Health and Care Research. The funders were not involved in the study design, interpretation of data or the writing of this manuscript. This work is supported by the following grants: The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute for Health and Care Research (grant references: MR/V027859/1 and COV0319). ISARIC4C is supported by grants from the National Institute for Health and Care Research (award CO-CIN-01) and the Medical Research Council (grant MC_PC_19059) Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research (grant reference: C18616/A25153). Other grants which have supported this work include: the UK Coronavirus Immunology Consortium [funder reference:1257927], the Imperial Biomedical Research Centre (NIHR Imperial BRC, grant IS-BRC-1215-20013), the Health Protection Research Unit (HPRU) in Respiratory Infections at Imperial College London and NIHR HPRU in Emerging and Zoonotic Infections at University of Liverpool, both in partnership with Public Health England, [NIHR award 200907], Wellcome Trust and Department for International Development [215091/Z/18/Z], Health Data Research UK (HDR UK) [grant code: 2021.0155], Medical Research Council [grant code: MC_UU_12014/12], and NIHR Clinical Research Network for providing infrastructure support for this research. FL is supported by an MRC clinical training fellowship [award MR/W000970/1]. LPH is supported by Oxford NIHR Biomedical Research Centre. AART is supported by a BHF Intermediate Clinical Fellowship (FS/18/13/33281). SLRJ receives support from UKRI, GCRF, Rosetrees Trust, BHIVA, EDCTP, Globvac. JDC has grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences, Grifols, Novartis and Insmed. RAE holds a NIHR Clinician Scientist Fellowship (CS-2016-16-020). AH is currently supported by UK Research and Innovation. NIHR and NIHR Manchester BRC. BR receives support from BHF Oxford Centre of Research Excellence, NIHR Oxford BRC and MRC. SJD is funded by an NIHR Global Research Professorship [NIHR300791]. DW is supported by an NIHR Advanced Fellowship. AH has received support from MRC and the Coronavirus Immunology Consortium (MR/V028448/1). LVW has received support from UKRI, GSK/Asthma + Lung UK and NIHR for this study. MGS has received support from NIHR UK, MRC UK and Health Protection Research Unit in Emerging & Zoonotic Infections, University of Liverpool. JKB is supported by the Wellcome Trust (223164/Z/21/Z) and UKRI (MC_PC_20004, MC_PC_19025, MC_PC_1905, MRNO2995X/1, and MC_PC_20029). PJMO is supported by a NIHR Senior Investigator Award [award 201385]. LT is supported by the Wellcome Trust [clinical career development fellowship grant number 205228/Z/16/Z], the Centre of Excellence in Infectious Diseases Research (CEIDR) and the Alder Hey Charity.

The use of mobile technologies to improve health outcomes or mobile health is rapidly evolving, and culturally relevant resources are needed to address health disparities among vulnerable populations. Noncommunicable disease health disparities among Asian Indian migrants to Hong Kong are prevalent. A mobile health application designed to improve hypertension and type 2 diabetes mellitus health literacy was tested using a mixed-methods design to determine its impact on improving health literacy among this subpopulation. Quantitative findings indicated the mobile health application was effective in improving health literacy. Qualitative findings revealed participant perceptions about the application explored its informative nature, usability and likability of application components, and its ability to initiate intentionality for a healthier lifestyle among users. This feedback was valuable to ensure future modifications that will promote the application's scalability and sustainability.

PurposeThe purpose of this paper is to understand how to build and implement information and communication technology (i.e. ICT) to help vulnerable people when significant social, cultural and economic barriers exist between the stakeholders.Design/methodology/approachThe authors followed an action research approach to design and implement a mobile health hypertension education application to help India's most vulnerable populations. The authors used interpretive analysis, guided by the sustainable livelihoods framework, to uncover key findings.FindingsSuccessfully implementing information and communication technology for development (ICT4D) requires understanding that all stakeholders (i.e. donors, facilitators and the beneficiaries) have important assets to contribute. Facilitators play an important role in connecting donors to the beneficiaries and fostering cultural humility in donors so that the donors will understand the role beneficiaries play in success. Stakeholders may use the ICT4D in unintended ways that both improve the people's health and increase some beneficiaries' financial livelihood.Research limitations/implicationsThis research expands the definition of information systems success when implementing ICT4D in resource-constrained environments. Success is more than creating an mHealth app that was easy for beneficiaries to use and where they learned based on a pre- and post-test statistical analysis. Success involved development in all the stakeholders impacted by the social innovation collaboration. For the beneficiary community, success included getting screened for noncommunicable diseases as a first step toward treatment. For the facilitator, success involved more resources for their community health program. Amongst the donors, success was a change in perspective and learning cultural humility.Practical implicationsAlthough universities encourage faculty to work in interdisciplinary research teams to address serious world problems, university researchers may have to exert considerable effort to secure contracts, approvals and payments. Unfortunately, universities may not reward this effort to build ICT4D and continue to evaluate faculty based on journal publications. When universities undertake social innovation collaborations, administrators should ensure responsive and flexible university processes as well as appropriate academic reward structures are in place. This need is heightened when collaborations involve international partners with limited resources and time needed to build relationships and understanding across cultures.Social implicationsThis study discovered the importance of fostering cultural humility as a way of avoiding potential conflicts that may arise from cultural and power differences. Cultural humility moves the focus of donor-beneficiary relationships away from getting comfortable with “them” to taking actions that develop relationships and address vulnerabilities (Fisher-Borne et al., 2015). This research shows how the facilitator helped the donor develop cultural humility by involving the donor in various initiatives with the beneficiary community including allowing the donor to live in a dormitory at the hospital, work in an urban slum and visit health screening campus.Originality/valueThis study (1) extends the ICT4D literature by incorporating cultural humility into the sustainable livelihoods framework, (2) provides a contextual understanding of developing cultural humility in ICT4D projects with a complex group of stakeholders and (3) describes how facilitators become a catalyst for change and a bridge to the community. The culturally humble approach suggests revising the livelihood framework to eliminate words like “the poor” to describe beneficiaries.

Advancements in methods for identifying RNA-protein interactions (RPIs) on a large scale has necessitated the development of assays for validation of these interactions, particularly in living cells. We previously reported the development of RiPCA (RNA interaction with protein-mediated complementation assay) to enable the cellular detection of the well-characterized interaction between the pre-microRNA, pre-let-7, and its RNA-binding protein (RBP) partner Lin28. In this study, the applicability of RiPCA for the detection of putative pre-miRNA-protein interactions was explored using an improved RiPCA protocol, termed RiPCA 2.0. RiPCA 2.0 was adapted to detect the sequence specificity of the RBPs hnRNP A1, Msi1, and Msi2 for reported pre-microRNA binding partners. Additionally, the ability of RiPCA 2.0 to detect site-specific binding was explored. Collectively, this work highlights the versatility of RiPCA 2.0 in detecting cellular RPIs.

Chronic back pain (CBP) is a condition that places a considerable burden on society, with several million people affected in the United States alone. Treatment options to address this problem and relieve CBP are constantly evolving, and one of the most promising treatment modalities for CBP that is refractory to conservative treatment options is endoscopic rhizotomy (ER).A thorough search of the PubMed (MEDLINE) database was conducted to assess the full progression of ER from its earliest uses to present day in a historical narrative review of ER, with treatment of facetogenic pain as a model pathology.ER allows for direct visualization and ablation of sensory branches of the dorsal ramus to provide pain relief in up to 80% of patients faced with refractory CBP. This technique has been built upon since the early 20th century, and the novel endoscopic approach continues to gain popularity among physicians. Benefits of ER include superior postoperative median pain-free duration compared with traditional percutaneous radiofrequency ablation, as well as direct visualization of regional anatomy. Patient selection criteria for the procedure and a modest list of contraindications allow the use of ER as a viable treatment option for a significant population of patients suffering from CBP. Potential barriers to ER include high cost of the procedure, longer intraoperative time, and expensive proprietary equipment.ER is an effective treatment for refractory CBP with notable advantages. As the technology and popularity of this procedure progress, improvements in the cost, training, and intraoperative time may make it a favorable alternative to the current standard of care.

Nonlinear transmission lines (NLTLs), which exhibit permittivity as a function of electric field and/or permeability as a function of magnetic field strength, are of increasing importance for sharpening pulses to less than 100 ps and serving as radio frequency (RF) sources; however, NLTLs often are not easily modified to achieve different output parameters. One method under investigation involves combining nonlinear dielectric [barium strontium titanate (BST)] and/or magnetic [nickel zinc ferrite (NZF)] inclusions to tune the NLTL properties by adjusting the inclusion loading fractions. This article focuses on measuring the nonlinear permeability and magnetic loss tangent of composites comprising various volume loadings of NZF or NZF and BST inclusions encapsulated in a silicon matrix. We measured the relative permeability from 1 to 4 GHz using a coaxial airline while biasing the samples in an external dc magnetic field from 0 to 171 kA/m. The permeability decreased from 1 to 4 GHz for each volume fraction but increased with increasing magnetic field strength at low-magnetic field strengths with sufficient NZF volume loading. The magnetic loss tangent of the composites increased with increasing frequency and/or NZF volume fraction but was suppressed by increasing the external magnetic field strength. Adding BST to NZF composites did not cause a significant change in permeability compared to NZF alone, based on an analysis of variance (ANOVA) and multiple comparison test. These results elucidate the frequency dependence of NZF volume loading at microwave frequency and provide initial information for simulating NLTLs and examining more comprehensive RF system behavior.

[Image: see text] MicroRNAs (miRNAs) are a family of small noncoding RNAs that regulate gene expression. Due to their important activity in the fine-tuning of protein translation, abnormal expression of miRNAs has been linked to many human diseases, making the targeting of miRNAs attractive as a novel therapeutic strategy. Accordingly, researchers have been heavily engaged in the discovery of small molecule modulators of miRNAs. With an interest in the identification of new chemical space for targeting miRNAs, we developed a high-throughput screening (HTS) technology, catalytic enzyme-linked click chemistry assay (cat-ELCCA), aimed at the discovery of small molecule ligands for pre-miR-21, a miRNA that is frequently overexpressed in human cancers. From our HTS campaign, we found that natural products, a source of many impactful human medicines, may be a promising source of potential pre-miR-21-selective maturation inhibitors. Herein we describe our first efforts in natural product inhibitor discovery leading to the identification of a depsipeptide class of natural products as RNA-binding inhibitors of Dicer-mediated miRNA processing.

The World Health Organization called for mobile health initiatives to improve population health outcomes, particularly in limited-resource settings. The aim of our study was to reflect upon approaches embedded in cultural humility and recognize areas where improvement was needed in the social innovation collaborative development of an mHealth app to improve hypertension health literacy in India. A qualitative descriptive case study approach was employed to elicit concepts of cultural humility and areas for improvement derived from communications between project stakeholders. Overarching themes included fostering coalescence and strengthening partnerships in addition to multiple subthemes. Enveloping cultural humility in multidisciplinary, interprofessional and cross-cultural healthcare projects and processes is imperative for the development and implementation of successful culturally congruent health initiatives. Team fostering of coalescence and recognizing challenges and adapting to mitigate challenges can strengthen partnerships, a desired consequence of cultural humility.

Following publication of the original article [1], we were notified that the first and last author names have been swapped. The original article has been corrected., SCOPUS: er.j, info:eu-repo/semantics/published

Background: Health inequities are prevalent in the United States and globally; however, racism as a root cause for health inequities is not explicitly addressed in most nursing or health science curricula. Method: Nursing students enrolled in an undergraduate Bachelor of Science in Nursing research course were immersed in a trip to a Holocaust and Human Rights Museum as a nontraditional experiential approach to building upstanders for health equity. Results: Students used their experiences to inspire research to advocate for health equity for vulnerable populations and disseminated their research at local, national, and international conferences. Conclusion: Nurse educators are responsible for ensuring nursing curricula are current and inclusive to address the health needs of patients and communities and to improve patient and population health outcomes. Embedding an immersive experience and related assignments is one strategy toward dismantling structural racism in health care. [ J Nurs Educ . 2022;61(7):417–420.]

Single cell microinjection provides precise tuning of the volume and timing of delivery into the treated cells; however, it also introduces workflow complexity that requires highly skilled operators and specialized equipment. Laser-based microinjection provides an alternative method for targeting a single cell using a common laser and a workflow that may be readily standardized. This paper presents experiments using a 1550 nm, 100 fs pulse duration laser with a repetition rate of 20 ns for laser-based microinjection and calculations of the hypothesized physical mechanism responsible for the experimentally observed permeabilization. Chinese Hamster Ovarian (CHO) cells exposed to this laser underwent propidium iodide uptake, demonstrating the potential for selective cell permeabilization. The agreement between the experimental conditions and the electropermeabilization threshold based on estimated changes in the transmembrane potential induced by a laser-induced plasma membrane temperature gradient, even without accounting for enhancement due to traditional electroporation, strengthens the hypothesis of this mechanism for the experimental observations. Compared to standard 800 nm lasers, 1550 nm fs lasers may ultimately provide a lower cost microinjection method that readily interfaces with a microscope and is agnostic to operator skill, while inducing fewer deleterious effects (e.g., temperature rise, shockwaves, and cavitation bubbles).

Recent efforts in genome-wide sequencing and proteomics have revealed the fundamental roles that RNA-binding proteins (RBPs) play in the life cycle and function of coding and non-coding RNAs. While these methodologies provide a systems-level view of the networking of RNA and proteins, approaches to enable the cellular validation of discovered interactions are lacking. Leveraging the power of bioorthogonal chemistry- and split-luciferase-based assay technologies, we have devised a conceptually new assay for the live-cell detection of RNA-protein interactions (RPIs), RNA interaction with Protein-mediated Complementation Assay, or RiPCA. As proof-of-concept, we utilized the interaction of the pre-microRNA, pre-let-7, with its binding partner, Lin28. Using this system, we have demonstrated the selective detection of the pre-let-7-Lin28 RPI in both the cytoplasm and nucleus. Furthermore, we determined that this technology can be used to discern relative affinities for specific sequences as well as of individual RNA binding domains. Thus, RiPCA has the potential to serve as a useful tool in supporting the investigation of cellular RPIs.

Background: So far, 3 randomized controlled trials have shown that the endobronchial treatment using coils is safe and effective. However, the more exact underlying mechanism of the treatment and best predictors of response are unknown. Objectives: The aim of the study was to gain more knowledge about the underlying physiological mechanism of the lung volume reduction coil treatment and to identify potential predictors of response to this treatment. Methods: This was a prospective nonrandomized single-center study which included patients who were bilaterally treated with coils. Patients underwent an extensive number of physical tests at baseline and 3 months after treatment. Results: Twenty-four patients (29% male, mean age 62 years, forced expiratory volume in 1 s [FEV1] 26% pred, residual volume (RV) 231% pred) were included. Three months after treatment, significant improvements were found in spirometry, static hyperinflation, air trapping, airway resistance, treated lobe RV and treated lobes air trapping measured on CT scan, exercise capacity, and quality of life. The change in RV and airway resistance was significantly associated with a change in FEV1, forced vital capacity, air trapping, maximal expiratory pressure, dynamic compliance, and dynamic hyperinflation. Predictors of treatment response at baseline were a higher RV, larger air trapping, higher emphysema score in the treated lobes, and a lower physical activity level. Conclusions: Our results confirm that emphysema patients benefit from endobronchial coil treatment. The primary mechanism of action is decreasing static hyperinflation with improvement of airway resistance which consequently changes dynamic lung mechanics. However, the right patient population needs to be selected for the treatment to be beneficial which should include patients with severe lung hyperinflation, severe air trapping, and significant emphysema in target lobes.

While exact analytic solutions for space-charge-limited currents (SCLCs) are well-established for parallel plate geometries, they have only recently been derived for concentric cylindrical and spherical geometries using variational calculus (VC). However, actual diode systems and slow-wave structures are usually more complicated, making SCLC calculations more difficult. In this article, we apply conformal mapping to derive the analytical solutions for SCLC for various complicated geometries exhibiting curvilinear flow. We first replicate the exact solution of SCLC for concentric cylindrical electrodes from VC using conformal mapping to transform from the Child–Langmuir (CL) law for a planar geometry. We then derive SCLC in other geometries using conformal transformations to either the planar or the concentric cylinder solution. Because the SCLC calculated using such conformal mappings depends only on the CL law, this may permit future incorporation of relativistic or quantum corrections to determine the appropriate relationships for more complicated geometries.

Enzyme-linked immunosorbent assay (ELISA) is the gold standard method for protein biomarkers. However, scaling up ELISA for multiplexed biomarker analysis is not a trivial task due to the lengthy procedures for fluid manipulation and high reagent/sample consumption. Herein, we present a highly scalable multiplexed ELISA that achieves a similar level of performance to commercial single-target ELISA kits as well as shorter assay time, less consumption, and simpler procedures. This ELISA is enabled by a novel microscale fluid manipulation method, composable microfluidic plates (cPlate), which are comprised of miniaturized 96-well plates and their corresponding channel plates. By assembling and disassembling the plates, all of the fluid manipulations for 96 independent ELISA reactions can be achieved simultaneously without any external fluid manipulation equipment. Simultaneous quantification of four protein biomarkers in serum samples is demonstrated with the cPlate system, achieving high sensitivity and specificity (∼ pg/mL), short assay time (∼1 h), low consumption (∼5 μL/well), high scalability, and ease of use. This platform is further applied to probe the levels of three protein biomarkers related to vascular dysfunction under pulmonary nanoparticle exposure in rat's plasma. Because of the low cost, portability, and instrument-free nature of the cPlate system, it will have great potential for multiplexed point-of-care testing in resource-limited regions.

Hospitalized burn patients meet the criteria for Virchow’s triad (endothelial damage, hypercoagulability, and stasis), predisposing them to venous thromboembolism (VTE). Although the disease burden of VTE suggests a need for prevention in this population, unreliable reported VTE rates, costly and complicated prophylaxis regimens, and chemoprophylaxis risks have prevented the establishment of a universal protocol. This paper reviews thromboprophylaxis practices both in the literature and at our own institution. A systematic review was conducted according to PRISMA guidelines identifying studies pertaining to VTE chemoprophylaxis in burn patients. Additionally, medical records of patients admitted to an American Burn Association-verified burn center between June 2015 and June 2019 were retrospectively reviewed for demographics, chemoprophylaxis, and presence of VTE defined as either deep vein thrombosis (DVT) or pulmonary embolism (PE). Thirty-eight studies met inclusion criteria. In the 12 studies that reported VTE incidence, rates ranged widely from 0.25% to 47.1%. The two largest retrospective studies (n = 33,637 and 36,638) reported a VTE incidence of 0.61% and 0.8% in populations with unknown or inconsistently recorded chemoprophylaxis. Throughout the literature, prevention protocols were mixed, though a trend toward using dose-adjusted subcutaneous low molecular weight heparin based on serum anti-factor Xa level was noted. At our burn center, 1,068 patients met study criteria. At-risk patients received a simple chemoprophylaxis regimen of 5000U of subcutaneous unfractionated heparin every 8 hours. No routine monitoring tests were performed to limit cost. Nine cases of DVT and two cases of PE were identified with an incidence of 0.84% and 0.19%, respectively, and a total VTE incidence of 1.03%. Only one patient developed heparin-induced thrombocytopenia (HIT). No cases of other heparin-associated complications were observed. VTE incidence rates reported in the literature are wide-ranging and poorly capture the effect of any one chemoprophylaxis regimen in the burn population. Our center uses a single, safe, and cost-effective protocol effecting a low VTE rate comparable to that of large national retrospective studies.

Multiple studies have demonstrated atmospheric cold plasma as an effective non-thermal technology for inactivating bacteria, spores, and other microbial contaminants in foods and on non-food surfaces. However, few studies have applied this technique to semi-solid food within a package. This study evaluates the efficacy and the interaction mechanism of high voltage atmospheric cold plasma (HVACP) on Salmonella enterica serovar Typhi (S. enterica) inactivation in agar gels with different compositions. HVACP was generated by a dielectric barrier discharge in air and a modified atmosphere (MA65: 65% O2) in sealed bags. Agar gels of various densities with a pH indicator were inoculated with S. enterica (> 107 cfu) and exposed directly (between the electrode) or indirectly (adjacent to electrode) to 90 kV at 60 Hz for up to 1.5 h. HVACP treatment induced greater than 6 log10 (cfu) reduction in viable bacteria (both with air and MA65) in the plasma penetrated zone exhibiting a pH change. Inactivation of bioluminescent E. coli K12-lux cells in the plasma penetrated zone confirmed that the plasma, and its generated reactive species, inactivates microbes as it penetrates into the gel. A two-minute HVACP treatment resulted in greater than 5 log10 (cfu) S. enterica reduction in applesauce. In summary, these results demonstrate that HVACP can be an effective non-thermal technology to control or even eliminate bacteria populations in semi-solid foods.

Aim The purpose of this research was to determine the effectiveness of a mobile health or mHealth application to improve hypertension health literacy among vulnerable populations in India. Additionally, we sought to estimate relationships between participant knowledge on hypertension and sociodemographic variables. Background The World Health Organization advocates for the use of mobile technology to improve public health outcomes. Introduction The incidence of hypertension is on the rise in India, and effective and sustainable interventions are needed. Methods A quantitative single arm pre-test post-test interventional and correlational design was used to test the hypertension mHealth application among participants in a limited resource setting. A paired t-test was performed to compare pre- and post-test results after participant use of the mHealth application. A regression model was used to estimate relationships between participant hypertension health literacy and sociodemographic variables. Results A statistically significant improvement in test scores among participants after use of the mHealth app was found. Sociodemographic characteristics such as living in an urban environment, married, increased number of people living in household and alcohol use were determined to have a statistically significant effect on improvement of test score. Discussion Results indicated the application was effective among participants with varied literacy and health literacy levels. These findings contribute to the potential widespread scalability of the app among populations with varied demographics. Conclusion This application provides an effective and valuable culturally tailored educational resource for nurses and other health providers to use to improve hypertension health literacy among vulnerable populations in India. Implications for nursing practice and health policy This study contributes to nursing and health policy by answering a call from the World Health Organization to implement and research mHealth interventions to improve health outcomes, particularly in a low and middle income country where preventive health access is limited.

INTRODUCTION There is an ongoing shortage of burn specialists, and workforce reports suggest possible hurdles attracting plastic surgeons into burn care. The purpose of this study was to (1) determine the state of burn care in plastic surgery residency and (2) identify what barriers might exist for plastic surgeons pursuing a practice that involves burn care. METHODS Surveys were distributed to North American plastic surgery program directors and residents, respectively, during the 2018-2019 academic year. RESULTS Fifty-eight program directors (response, 54%) and 320 plastic surgery residents (response, 30%) participated. Burn care was felt to be an important component in training by most program directors (USA, 88%; Canada, 100%) and residents (USA, 87%; Canada, 99%). The majority of program directors included a burn unit rotation (USA, 88%; Canada, 90%). Rotations for integrated residents averaged 2.5 months and most commonly occurred during second year; independent residents spent 1.2 months on rotation, usually in first year. Three-quarters of American residents were interested in a career that involves burn care in some capacity, primarily burn reconstruction (40%). Factors that would discourage a trainee from practicing burn care in the future included the nature of burn care (60%) and burn operations (45%), the on-call commitment (39%), and a narrow scope of practice (38%). DISCUSSION This study challenges the belief that plastic surgery trainees are disinterested in burn care. Burn surgery remains an important component of training programs, and we propose several steps to encourage greater interest and participation in the burn surgery workforce.

Stimulant (cocaine, methamphetamine, and amphetamine) abuse compromises the peripheral vasculature through endothelial injury. In combination with the physiologic derangements seen in burn injuries, patients abusing stimulants may have additional impairments in wound healing. A retrospective review from July 1, 2015 to July 1, 2018 was performed at an American Burn Association-verified burn center. Patients with positive urine toxicology results for stimulants (ST(+)), and those without (ST(−)), who sustained burn injuries were identified and matched by age and TBSA. The primary outcome was mortality, and secondary outcomes included total length of stay (LOS), and need-for-surgery (grafting). In total, 130 patients ST(+) and 133 ST(−) patients were identified. There were no significant differences in age (40.9 ± 13.5 vs 39.2 ± 23.7 years, P = 0.46), Inhalation Injury (12.3 vs 9.0%, P = 0.39), or nutritional status (prealbumin: 17.3 ± 6.1 vs 17.1 ± 12.7 mg/dl, P = 0.66; albumin: 3.5 ± 0.6 vs 3.6 ± 0.7 g/dl, P = 0.45). There were no differences in mortality (6.1 vs 4.5%, P = 0.55), intensive care unit LOS (9.3 ± 16.5 vs 10.2 ± 20.9 days, P = 0.81), wound infections (15.4 vs 23.9%, P = 0.07), or wound conversion (6.9 vs 3.0%, P = 0.14). ST(+) patients had a significantly longer LOS (15.0 ± 16.9 vs 10.7 ± 17.3 days, P = 0.04), greater tobacco use (56.9 vs 18.0%, P = 0.00001), and greater need for grafting (54.6 vs 33.1%, P = 0.0004). ST(+) patients require more hospital resources—surgical operations and hospital days—than ST(−) patients. The increased need for surgical intervention may partially explain the increase in hospital days, in addition to the observation that ST(+) patients had more complex disposition issues than ST(−) patients.

Paschen’s law (PL), derived based on the Townsend avalanche (TA) condition, is commonly used to predict gas breakdown. For microscale gaps near atmospheric pressure, TA is insufficient to drive breakdown and ion-enhanced field emission (FE) dominates. Accurately predicting breakdown voltages for these gaps is critical for numerous applications, including environmental remediation, medicine, combustion, and propulsion. This tutorial summarizes theoretical and computational approaches for predicting this behavior and demonstrating the transition between the TA and FE mechanisms. It focuses on the derivation of closed-form solutions from a theory that accounts for the generation of additional positive space charge at the cathode due to electrons generated by the strong FE-induced electric fields. Appropriate simplifications using a matched asymptotic analysis in terms of the total ionization in the gap agree well with simulations and experiments and show the transition from FE for small gaps to PL at larger gaps. Specifically, this theory shows that the breakdown voltage varies linearly with gap distance when FE dominates, agreeing with both the experimental and simulation results. The particle-in-cell Monte Carlo collision (PIC/MCC) simulations used to predict the ionization coefficient provide additional insight into the mechanisms involved. Future benefits of extended theoretical and computational research for examining microscale and nanoscale breakdown and electron emission, particularly assessing the impact of electrode surface structure and device design and coupling with additional emission mechanisms, will be discussed.

Background Few studies have addressed methods for evaluating simulation in low- and middle-income countries. Purpose To determine if participation in a simulation scenario improved self-efficacy in nursing competency among undergraduate nursing students in India and to assess relationship of self-efficacy scores and instructors' observed competency. Methods A one-arm pretest/post-test and correlational design was used. Results Self-efficacy post-test scores were significantly higher than pretest scores (p Conclusions Self-efficacy reporting may not be the most effective measure for evaluating nursing competency, and cultural implications may exist.

Placental health is critical to fetal growth and maternal health during gestation. However, investigating placental flow in an ex-vivo isolated system where inflow is independently controlled has yet to be developed in the rat. Here, we describe a novel technique, isolated perfused placenta technique that allows for analysis of placental pressure outflow pressure, placental flow in rats at gestational day 20. Using this method, we successfully perfused placentas from dams and were able to observe increases in outflow pressure and flow as the inflow pressure to the placenta was increased in a step wise fashion. This method will help to advance the functional analysis of placental flow and therefore placental resistance and efficiency.

Data sharing statement: PHOSP-COVID: The protocol, consent form, definition and derivation of clinical characteristics and outcomes, training materials, regulatory documents, requests for data access and other relevant study materials are available online at https://www.phosp.org. COVIDENCE UK: De-identified participant data will be made available upon reasonable request to the corresponding author. Supplementary data is available online at: https://www.sciencedirect.com/science/article/pii/S2666776223000546?via%3Dihub#appsec1 . Copyright © 2023 The Author(s). Background: The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea. Methods: We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up. Findings: We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01–1.03), male (1.54, 1.16–2.04), neither obese nor severely obese (1.82, 1.06–3.13 and 4.19, 2.14–8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09–2.22) or cardiovascular disease (1.33, 1.00–1.79), and shorter hospital admission (1.01 per day, 1.00–1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission). Interpretation: Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19. Funding: PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders. PHOSP-COVID: This study would not be possible without all the participants who have given their time and support. We thank all the participants and their families. We thank the many research administrators, health-care and social-care professionals who contributed to setting up and delivering the study at all of the 65 NHS trusts/Health boards and 25 research institutions across the UK, as well as all the supporting staff at the NIHR Clinical Research Network, Health Research Authority, Research Ethics Committee, Department of Health and Social Care, Public Health Scotland, and Public Health England, and support from the ISARIC Coronavirus Clinical Characterisation Consortium. We thank Kate Holmes at the NIHR Office for Clinical Research Infrastructure (NOCRI) for her support in coordinating the charities group. The PHOSP-COVID industry framework was formed to provide advice and support in commercial discussions, and we thank the Association of the British Pharmaceutical Industry as well NOCRI for coordinating this. We are very grateful to all the charities that have provided insight to the study: Action Pulmonary Fibrosis, Alzheimer's Research UK, Asthma + Lung UK, British Heart Foundation, Diabetes UK, Cystic Fibrosis Trust, Kidney Research UK, MQ Mental Health, Muscular Dystrophy UK, Stroke Association Blood Cancer UK, McPin Foundations, and Versus Arthritis. We thank the NIHR Leicester Biomedical Research Centre patient and public involvement group and Long Covid Support. COVIDENCE UK: We thank all participants of COVIDENCE UK, and the following organisations who supported study recruitment: Asthma UK/British Lung Foundation, the British Heart Foundation, the British Obesity Society, Cancer Research UK, Diabetes UK, Future Publishing, Kidney Care UK, Kidney Wales, Mumsnet, the National Kidney Federation, the National Rheumatoid Arthritis Society, the North West London Health Research Register (DISCOVER), Primary Immunodeficiency UK, the Race Equality Foundation, SWM Health, the Terence Higgins Trust, and Vasculitis UK.

Many signal processing applications require knowledge of where sources are located relative to the receiver. In cases where the source locations are not known in advance, methods must be implemented to estimate the direction of arrival (DOA) of the incoming signals. This paper proposes a method for estimating the DOA of acoustic signals in real time using a two-dimensional array of microphones. While many existing methods focus solely on obtaining an accurate estimate of one or more sound sources, the proposed method aims to provide a more complete picture of the sound field measured by the microphone array. This method can be easily adapted to identify and track any number of independent sources without a significant increase in either complexity or computational expense, making it suitable for applications where very little about the sound field can be known in advance.

Some patients hospitalized with acute COVID-19 suffer respiratory symptoms that persist for many months. We delineated the immune-proteomic landscape in the airway and peripheral blood of healthy controls and post-COVID-19 patients 3 to 6 months after hospital discharge. Post-COVID-19 patients showed abnormal airway (but not plasma) proteomes, with elevated concentration of proteins associated with apoptosis, tissue repair and epithelial injury versus healthy individuals. Increased numbers of cytotoxic lymphocytes were observed in individuals with greater airway dysfunction, while increased B cell numbers and altered monocyte subsets were associated with more widespread lung abnormalities. 1 year follow-up of some post-COVID-19 patients indicated that these abnormalities resolved over time. In summary, COVID-19 causes a prolonged change to the airway immune landscape in those with persistent lung disease, with evidence of cell death and tissue repair linked to ongoing activation of cytotoxic T cells., Graphical Abstract, Many individuals recovering from acute SARS-CoV-2 infection suffer prolonged respiratory dysfunction for months to years after viral clearance. Vijayakumar, Boustani, Ogger, Papadaki et al. show that individuals with persistent symptoms 3-6 months after infection have an altered airway immune cell landscape and evidence of ongoing lung damage. Importantly, different immune cell types correlate with the severity of distinct aspects of ongoing respiratory disease.

Understanding space-charge limited current density (SCLCD) is fundamentally and practically important for characterizing many high-power and high-current vacuum devices. Despite this, no analytic equations for SCLCD with nonzero monoenergetic initial velocity have been derived for nonplanar diodes from first principles. Obtaining analytic equations for SCLCD for nonplanar geometries is often complicated by the nonlinearity of the problem and over constrained boundary conditions. In this letter, we use the canonical coordinates obtained by identifying Lie-point symmetries to linearize the governing differential equations to derive SCLCD for any orthogonal diode. Using this method, we derive exact analytic equations for SCLCD with a monoenergetic injection velocity for one-dimensional cylindrical, spherical, tip-to-tip (t-t), and tip-to-plate (t-p) diodes. We specifically demonstrate that the correction factor from zero initial velocity to monoenergetic emission depends only on the initial kinetic and electric potential energies and not on the diode geometry and that SCLCD is universal when plotted as a function of the canonical gap size. We also show that SCLCD for a t-p diode is a factor of four larger than a t-t diode independent of injection velocity. The results reduce to previously derived results for zero initial velocity using variational calculus and conformal mapping., Comment: 18 pages, 3 figures