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We assessed the causal relation of four glycemic traits and type 2 diabetes liability with 167 metabolites using Mendelian randomization with various sensitivity analyses and a reverse Mendelian randomization analysis. We extracted instruments for fasting glucose, 2-h glucose, fasting insulin, and glycated hemoglobin from the Meta-Analyses of Glucose and Insulin-related traits Consortium (n = 200,622), and those for type 2 diabetes liability from a meta-analysis of multiple cohorts (148,726 cases, 965,732 controls) in Europeans. Outcome data were from summary statistics of 167 metabolites from the UK Biobank (n = 115,078). Fasting glucose and 2-h glucose were not associated with any metabolite. Higher glycated hemoglobin was associated with higher free cholesterol in small low-density lipoprotein. Type 2 diabetes liability and fasting insulin were inversely associated with apolipoprotein A1, total cholines, lipoprotein subfractions in high-density-lipoprotein and intermediate-density lipoproteins, and positively associated with aromatic amino acids. These findings indicate hyperglycemia-independent patterns and highlight the role of insulin in type 2 diabetes development. Further studies should evaluate these glycemic traits in type 2 diabetes diagnosis and clinical management.

Abstract Background Escherichia coli is the most common cause of human bloodstream infections and bacterial sepsis/septic shock. However, translation of preclinical septic shock resuscitative therapies remains limited mainly due to low-fidelity of available models in mimicking clinical illness. To overcome the translational barrier, we sought to replicate sepsis complexity by creating an acutely critically-ill preclinical bacterial septic shock model undergoing active 48-h intensive care management. Aim To develop a clinically relevant large-animal (ovine) live-bacterial infusion model for septic shock. Methods Septic shock was induced by intravenous infusion of the live antibiotic resistant extra-intestinal pathogenic E. coli sequence type 131 strain EC958 in eight anesthetised and mechanically ventilated sheep. A bacterial dose range of 2 × 105–2 × 109 cfu/mL was used for the dose optimisation phase (n = 4) and upon dose confirmation the model was developed (n = 5). Post-shock the animals underwent an early-vasopressor and volume-restriction resuscitation strategy with active haemodynamic management and monitoring over 48 h. Serial blood samples were collected for testing of pro-inflammatory (IL-6, IL-8, VEGFA) and anti-inflammatory (IL-10) cytokines and hyaluronan assay to assess endothelial integrity. Tissue samples were collected for histopathology and transmission electron microscopy. Results The 2 × 107 cfu/mL bacterial dose led to a reproducible distributive shock within a pre-determined 12-h period. Five sheep were used to demonstrate consistency of the model. Bacterial infusion led to development of septic shock in all animals. The baseline mean arterial blood pressure reduced from a median of 91 mmHg (71, 102) to 50 mmHg (48, 57) (p = 0.004) and lactate levels increased from a median of 0.5 mM (0.3, 0.8) to 2.1 mM (2.0, 2.3) (p = 0.02) post-shock. The baseline median hyaluronan levels increased significantly from 25 ng/mL (18, 86) to 168 ng/mL (86, 569), p = 0.05 but not the median vasopressor dependency index which increased within 1 h of resuscitation from zero to 0.39 mmHg−1 (0.06, 5.13), p = 0.065, and. Over the 48 h, there was a significant decrease in the systemic vascular resistance index (F = 7.46, p = 0.01) and increase in the pro-inflammatory cytokines [IL-6 (F = 8.90, p = 0.02), IL-8 (F = 5.28, p = 0.03), and VEGFA (F = 6.47, p = 0.02)]. Conclusions This critically ill large-animal model was consistent in reproducing septic shock and will be applied in investigating advanced resuscitation and therapeutic interventions.

Abstract Introduction Burkina Faso faces many challenges in the health domain, with no real opportunity for an increase in public health expenditures. In Burkina Faso, as in all low-income countries, health spending efficiency is crucial. The objective of this paper is to assess the efficiency of Advanced Medical Centers (AMCs)—which correspond to district hospitals—in Burkina Faso over the 2017–2020 period and identify the factors that promote—or, on the contrary, limit—the efficiency of these health structures. Method We first assessed the efficiency level of the 45 AMCs running in the country between 2017 and 2020 using a bootstrap Data Envelopment Analysis (DEA) methodology. Inputs include the number of doctors, nurses, other medical staff, non-medical staff, and beds, while output variables correspond to the number of inpatients, surgeries, outpatients, and inpatient days. In a second step, determinants of AMC’s efficiency levels were explored using a double-bootstrap procedure. The roles of AMCs’ internal and environmental factors were both considered. Results We found a mean efficiency score of 0.51 over the study period, indicating that AMCs could have almost doubled their healthcare production without needing additional resources. The size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared to be the driving factors of AMCs’ efficiency. Conclusion Our results indicate that improving the efficiency of AMCs should be a high-level priority for the Burkinabe health policy. Resources could be reallocated across AMCs to increase the overall efficiency of the health system.

School counselling is a well-established means of supporting the mental health of children. Counsellors are most effective when they collaborate with parents, so it is important that parents have a good understanding of and access to school counselling services. Despite this, little is known about parents' perceptions of counselling in Hong Kong schools. We interviewed 27 parents in Hong Kong to investigate how they perceived the counselling services provided by their children's local and international schools, and analysed the data thematically. International school parents recognised the potential of school counselling as a means of support for their children and wanted to work more closely with counsellors to a greater extent than local school parents. Parents were confused about the roles of counsellors and experienced stigma and concerns about confidentiality which inhibited them from engaging with counselling services. Our findings suggest that school principals should work with counsellors to establish and communicate roles more clearly. Greater recognition of counsellors' professionalism, and clearer role differentiation between counsellors and other mental health and educational professionals may improve parental engagement with and support for school counselling.

Culture is a key determinant of children's development both in its own right and as a measure of generalizability of developmental phenomena. Studying the role of culture in development requires information about participants' demographic backgrounds. However, both reporting and treatment of demographic data are limited and inconsistent in child development research. A barrier to reporting demographic data in a consistent fashion is that no standardized tool currently exists to collect these data. Variation in cultural expectations, family structures, and life circumstances across communities make the creation of a unifying instrument challenging. Here, we present a framework to standardize demographic reporting for early child development (birth to 3 years of age), focusing on six core sociodemographic construct categories: biological information, gestational status, health status, community of descent, caregiving environment, and socioeconomic status. For each category, we discuss potential constructs and measurement items and provide guidance for their use and adaptation to diverse contexts. These items are stored in an open repository of context-adapted questionnaires that provide a consistent approach to obtaining and reporting demographic information so that these data can be archived and shared in a more standardized format.

In the past decade, moderated mediation analysis has been extensively and increasingly employed in social and behavioral sciences. With its widespread use, it is particularly important to ensure the moderated mediation analysis will not bring spurious results. Spurious effects have been studied in both mediation and moderation analysis, but this issue remains unexplored in moderated mediation analysis. To fill this gap, we examined the conditions under which a spurious moderated mediation effect in a dual stage moderated mediation model might occur. Specifically, with a hypothetical example and three theorems, we illustrated how the index of moderated moderated mediation may conclude a moderated mediation effect which does not actually exist. As a remedy to rule out the spurious results, we proposed two methods which are simple and easy to implement. Based on the simulation results, we offer researchers some practical guidelines to apply the methods in empirical research.

Abstract A fully generic treatment of electric dipole moments (EDMs) is presented in the CP-violating and flavor-conserving weak effective field theory (WET) with five flavors of quarks and three flavors of leptons. We systematically analyze leading contributions to EDMs originating from QCD and QED renormalization group running between the electroweak scale and low energy scales of about 2 GeV. We include the full one-loop anomalous dimension and a subset of two-loop corrections, as well as threshold corrections at the bottom, charm and τ masses. This allows us to derive master formulae in the space of generic WET for the neutron and proton EDMs, for EDMs of diamagnetic atoms, and for the precession frequencies constrained in molecular EDM experiments, from which bounds on the electron EDM are extracted. In particular, our master formulae capture the contributions of WET CP-violating operators with heavy quark and lepton flavors. As an application, we study EDM constraints on the Yukawa couplings of the Higgs boson, in both the linear and non-linear realizations of electroweak symmetry breaking.

Abstract Sterile neutrinos with masses at the keV scale and mixing to the active neutrinos offer an elegant explanation of the observed dark matter (DM) density. However, the very same mixing inevitably leads to radiative photon emission and the non-observation of such peaked X-ray lines rules out this minimal sterile neutrino DM hypothesis. We show that in the context of the Standard Model effective field theory with sterile neutrinos (νSMEFT), higher dimensional operators can produce sterile neutrino DM in a broad range of parameter space. In particular, νSMEFT interactions can open the large mixing parameter space due to their destructive interference, through operator mixing or matching, in the X-ray emission. We also find that, even in the zero mixing limit, the DM density can always be explained by νSMEFT operators. The testability of the studied νSMEFT operators in searches for electric dipole moments, neutrinoless double beta decay, and pion decay measurements is discussed.

Abstract Arterial endothelial cells (AECs) are the founder cells for intraembryonic haematopoiesis. Here, we report a method for the efficient generation of human haemogenic DLL4+ AECs from pluripotent stem cells (PSC). Time-series single-cell RNA-sequencing reveals the dynamic evolution of haematopoiesis and lymphopoiesis, generating cell types with counterparts present in early human embryos, including stages marked by the pre-haematopoietic stem cell genes MECOM/EVI1, MLLT3 and SPINK2. DLL4+ AECs robustly support lymphoid differentiation, without the requirement for exogenous NOTCH ligands. Using this system, we find IL7 acts as a morphogenic factor determining the fate choice between the T and innate lymphoid lineages and also plays a role in regulating the relative expression level of RAG1. Moreover, we document a developmental pathway by which human RAG1+ lymphoid precursors give rise to the natural killer cell lineage. Our study describes an efficient method for producing lymphoid progenitors, providing insights into their endothelial and haematopoietic ontogeny, and establishing a platform to investigate the development of the human blood system.