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PURPOSE: To evaluate the safety and efficacy of the recombinant tissue plasminogen activator alteplase in the clearance of poorly functioning tunneled hemodialysis catheters. METHODS: We retrospectively reviewed the outcomes of 25 patients who presented with poorly functioning hemodialysis catheters and were treated with alteplase. After confirming fluoroscopically the need for thrombolytic therapy, alteplase was administered over 2 hours as a 2.5-mg/hour/catheter lumen infusion (total 10 mg). Treatment was considered a clinical success if a flow rate of 250 mL or more per minute was established. RESULTS: Clinical success was achieved in each of 25 patients (100%). There were no thrombolytic-related complications. Catheter survival was extended 30 days in 54% of patients and 45 days in 33% of patients. CONCLUSION: Alteplase is a safe and effective means of producing clearance of blocked tunneled catheters. [ABSTRACT FROM AUTHOR]

A new flexible bis(amidine) ligand featuring two additional N-donor groups incorporates a defined [Cu I MesCu 2 I ] 2+ fragment from mesitylcopper into a triangular cluster with a reactive organometallic coordination site. Subtle changes to the reaction protocol result in the formation of an intertwined tetracuprous arrangement that adopts the shape of a Möbius strip.

Submaximal functional tests of endurance are ubiquitous in clinical practice. This investigation compared cardiovascular responses, perceived exertion, and performance measures following the completion of three self-paced, 2-minute, functional tests of endurance. A pilot prospective, observational, cross-sectional design with 16 community-dwelling older participants compared heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rating of perceived exertion (RPE), and performance measures following the completion of three randomly allocated self-paced activities. The three activities included 2 minutes of stepping in standing (2MSTD), 2 minutes of seated stepping (2MSIT), and a 2-minute walk test (2MWT). A within-subjects repeated measures ANOVA analyzed differences in change scores for cardiovascular and RPE responses. Pearson's correlations assessed associations in performance measures between the three tests. Standing stepping compared to seated stepping produced statistically higher change scores in HR, SBP, DBP, and RPE (p < .05). Further, 2MSTD revealed statistically higher SBP and RPE scores compared to 2MWT (p < .05). Large and moderate correlations were observed between number of steps completed in sitting and standing (r = 0.83, p < .01) and between standing steps and distance walked (r = 0.56, p = .02), respectively. This pilot investigation informs home care physical therapists that 2 minutes of self-paced stepping in standing produced the greatest change scores in all cardiovascular and perceived exertion responses. No significant differences were noted in HR between self-paced walking and standing stepping, and between standing and seated stepping. For patients unable to walk or step in standing, self-paced seated stepping may be a viable alternative., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Glucagon-like peptide-1 (GLP-1) analogs are approved for the treatment of obesity in adults and adolescents. Reports have emerged that the weight loss effect of these medications may be related to changes in food preferences and ingestive behaviors following the treatment. Understanding the mechanisms which impact ingestive behavior could expand opportunities to develop more refined and personalized treatment options for obesity., Methods: Recent studies investigating the relationship between GLP-1 analogs and ingestive behaviors were retrieved from PubMed using the search terms: "obesity," "food preference," "taste," "ingestive behavior," "weight loss medication," "anti-obesity medication," "GLP-1 analog," "tirzepatide," "liraglutide," "semaglutide." Measurement tools were studied to compare variables used to assess food intake behavior. The main outcomes from each study were analyzed to evaluate the current standing and future directions of appetitive, ingestive, and consummatory behaviors and their association with GLP-1 analogs., Results: Thus far, studies have primarily explored the weight loss phase and report decreased short-term appetite and food intake upon treatment. However, research during the weight maintenance phase and objective measurements of food intake are notably sparse. Additionally, verbal reports have been primarily used to examine food intake, which can be susceptible to subjectivity., Conclusions: Elucidating the relationship between GLP-1 analogs and ingestive behavior could reveal additional parameters which contribute to their anti-obesity effects. To better understand these mechanisms, it is imperative to consider objective measurements of food intake in future studies. Several measurement tools have been adapted to measure variables of food behavior in humans, and each must be carefully considered with their strengths and limitations to develop optimal investigations., (© 2024. The Author(s).)

Joint luxations commonly occur in animals secondary to traumatic injury. Because of the unique hind-limb anatomy of macropods, surgical stabilization of orthopedic injuries is considered challenging, and reports of successful management are limited. A 4-yr-old male neutered red kangaroo ( Osphranter rufus ) presented with a dorsolateral luxation of the left tibiotarsal joint. Surgical reduction and tarsal arthrodesis were performed. Although the full range of motion of the tarsal joint was limited, this kangaroo was still able to ambulate normally at slow speeds following surgery and recovery. The aim of this report was to describe the surgical and postoperative management of a tibiotarsal luxation in a kangaroo. There were significant postoperative complications in this kangaroo, and antibiotic regional limb perfusion was used to treat wound and implant infection.

Introduction: Education in interprofessional collaboration is vital to expand healthcare access, especially in areas of higher disparity. To address this need, interprofessional faculty collaborators incorporated undergraduate and graduate health profession students into teams at an annual Remote Area Medical event in rural Appalachia between 2017 and 2020., Purpose: This article evaluates the impact of an interprofessional student teams model on both patient care experience and students' interprofessional collaboration attitudes and behaviors., Methods: Student volunteers completed pre- and post-event surveys containing questions about demographics, open-ended questions, and questions from two instruments: the Student Perceptions of Interprofessional Clinical Education-Revised Instrument, Version 2 (SPICE-R2) and the Interprofessional Collaborative Competency Attainment Scale-Revised (ICCAS-R). Quantitative data were analyzed statistically; qualitative data thematically. Tally forms collected patient care interventions that were compared to regional health disparities. Two years of survey data and four years of intervention data were analyzed., Results: There was an increase ( p < 0.001) in the post-event survey SPICE-R2 factors (teamwork, healthcare outcomes, and roles and responsibilities) in 2020 but not in 2019. ICCAS-R mean post-event composite scores increased ( p < 0.05) in both 2019 and 2020. Qualitative coding of open-ended responses revealed interprofessional competency themes and provided event feedback. Over 5,900 health-disparity-focused interventions were completed between 2017 and 2020., Implications: Students participating in interprofessional teams demonstrate changes in attitudes towards the interprofessional approach to care, an improved ability to collaborate interprofessionally, and a positive impact on patient care interventions. The findings allow educators to understand how experiential interprofessional education influences students' interprofessional attitudes and beliefs while benefitting patient care., Competing Interests: Cover Page Footnote No competing financial or editorial interests were reported by the authors of this paper., (Copyright © 2023 Emily K. Flores, KariLynn Dowling, Caroline Abercrombie MD, and Rick L. Wallace.)

Makueni County, located in south-eastern Kenya, faces challenges such as limited potable water and restricted food supplies as the result of semi-aridity. High fluoride (F) concentrations have been reported in drinking water with resultant dental fluorosis affecting the local population. To determine the potential F exposure through the consumption of food crops grown in the area, F concentration was assessed in the main five locally grown and consumed crops. Additionally, the water-soluble F fraction was determined from 30 soil samples with mineralogical determination of 20 samples. Mean F concentration in the food crops was in the order; 700, 288, 71.2, 36.6, and 29 mg/kg in kale, cowpeas leaves, green grams, cowpeas (legume portion), and maize, respectively. The F concentration in farm soils ranged from 0 to 3.47 mg/kg (mean of 0.87 mg/kg) and showed a significant strong positive correlation (p = 0.03, r = 0.89) with F values in the crops. Apatite, muscovite, and biotite were identified as the F-rich minerals present. While considering two hypothetical F absorption fractions (75 and 100%), the estimated average daily dose (EADD) of F from consuming the crops ranged between 0.004 and 65.17 mg/kg/day where the highest values were from the vegetables. Most of these values were higher than the F reference dose (RfD) of 0.06 mg/kg. The estimated EADD values of several hypothetical meals prepared from the analyzed crops revealed that steamed kale and maize porridge pose the highest health risk of F associated diseases to the local population, whereas boiled cowpeas pose no health risk. Children, due to their higher daily energy requirement and low body weight, were the most vulnerable group at risk of high daily F intake relative to the RfD. These results suggest that consumption of the analyzed food crops in Makueni County may significantly contribute to F related diseases in the local population. This creates a food security issue for the area because of the potential health risks associated with these crops which are highly relied upon in the semi-arid area with a limited selection of food crops available and viable to grow., (© 2022. The Author(s).)

Bread wheat (Triticum aestivum L.) is one of the most important food crops, however it is only moderately tolerant to salinity stress. To improve wheat yield under saline conditions, breeding for improved salinity tolerance of wheat is needed. We have identified nine quantitative trail loci (QTL) for different salt tolerance sub-traits in a recombinant inbred line (RIL) population, derived from the bi-parental cross of Excalibur × Kukri. This population was screened for salinity tolerance subtraits using a combination of both destructive and non-destructive phenotyping. Genotyping by sequencing (GBS) was used to construct a high-density genetic linkage map, consisting of 3236 markers, and utilised for mapping QTL. Of the nine mapped QTL, six were detected under salt stress, including QTL for maintenance of shoot growth under salinity (QG ( 1-5 ) .asl -5A , QG ( 1-5 ) .asl -7B ) sodium accumulation (QNa.asl -2A ), chloride accumulation (QCl.asl -2A , QCl.asl -3A ) and potassium : sodium ratio (QK :Na.asl -2DS2 ). Potential candidate genes within these QTL intervals were shortlisted using bioinformatics tools. These findings are expected to facilitate the breeding of new salt tolerant wheat cultivars. Soil salinity causes major yield losses in bread wheat, which is moderately tolerant to salinity stress. Using high throughput genotyping and phenotyping techniques, we identified quantitative trail loci (QTL) for different salt tolerance sub-traits in bread wheat and shortlisted potential candidate genes. These QTL and candidate genes may prove useful in breeding for salt tolerant wheat cultivars.

Due to the semi-arid nature of Makueni County in South-Eastern Kenya, there is a high dependence on groundwater resources for domestic use. Reliance on this source of potable water may have health implications for the population, given the presence of several naturally occurring and potentially harmful elements reported from aquifer source rocks, soil, and water in the area. A survey involving questionnaires and focus group discussions (FGDs) was conducted with 115 individuals to determine the local population's knowledge, attitude, and perceptions of their drinking water quality and its health impacts. The results show that most respondents (67%) preferred piped water because it was pre-treated and not saline. Only 29% of the respondents were very satisfied with the taste of their drinking water, while the rest complained about varying salinity levels, ranging from slightly salty to very salty. This low satisfaction might have influenced the low daily drinking water consumption (1-2 L) by most respondents. Health issues reported by many (43%) respondents in the area include diarrhoea and gastrointestinal upsets, which may be associated with the saline nature of the drinking water. Elevated fluoride (F - ) in the local groundwater was reported, and the health effects remain a concern. Although 91% knew someone with dental fluorosis, 53% did not know the deleterious effects of high F - in drinking water. Most respondents (59%) associated the salty nature of the water with dental fluorosis, and as a result, 48% avoided drinking the salty water to prevent the condition. Despite the high prevalence and known psycho-social effects, most people did not perceive dental fluorosis as a severe health threat. The increased health risks associated with high salinity and high F - in drinking water in Makueni County are poorly understood by most residents, regardless of their education, gender, or age. This warrants an immediate public health education programme and detailed epidemiological studies to determine all the health effects associated with naturally occurring, potentially harmful elements in groundwater in the area.

Transthoracic echocardiography presents a risk of COVID-19 transmission between an echocardiographer and the patient. Reducing the scanning time is likely to mitigate this risk for them both. British Society of Echocardiography (BSE) level 1 echocardiography offers a potential framework for focused scanning in an outpatient setting. There were 116 outpatients scheduled for a level 1 scan supplemented with additional predefined views, if required. Unexpectedly, a fifth of the scans were performed as an unintended full scan for a variety of reasons. Our results showed that focused scans were performed more quickly than full scans and below the NHS Test and Trace exposure cut-off of 15 minutes. However, if more than three sets of additional measurements were required then a full scan could be performed more quickly. Seniority of the echocardiographer and scan time had an inverse relationship. By examining the patients' clinical records we were confident that all of the scans, whether focused or full, had answered the requestor's clinical question. Although the COVID-19 vaccination programme should reduce the necessity of minimising exposure time during a scan there could still be a role for level 1 scanning during the COVID-19 recovery programme to tackle the vast lists of patients waiting for an echocardiogram., Competing Interests: Conflicts of interest None declared., (Copyright © 2021 Medinews (Cardiology) Limited.)

Compared to other countries, the COVID-19 pandemic did not severely affect Australia as measured by total deaths until mid-2021. Though a substantial number of daily confirmed cases (up to 698) were reported during the second wave, most of them were from the southern state of Victoria. This study examined the possible correlations between climate variables and the number of daily confirmed COVID-19 cases in Victoria, Australia, from 25 January to 31 October 2020. Appropriate regression models and cross-correlation diagnostics were used to examine the effect of temperature, rainfall, solar exposure, and ultraviolet index (UVI) with the number of daily confirmed cases. Significant positive associations were identified for solar exposure and maximum and average UVI for confirmed cases one and 19 days later. Negative associations for these variables were found for confirmed cases five days later. Minimum temperature had a significant negative correlation one day later and a positive effect 21 days later. No significant correlation was found for maximum temperature and rainfall. The most significant relationships were found for confirmed cases 19 days after changes in the meteorological variables. A 1% increase in solar exposure, maximum UVI, and average UVI was associated with a 0.31% (95% CI: 0.13 to 0.51), 0.71% (95% CI: 0.43 to 0.98), and 0.63% (95%CI: 0.20 to 1.61) increase 19 days later in the number of confirmed cases, respectively. The implications of these results can be used in the public health management of any possible future events in Australia. It also highlights the significance of considering the climatic variables and seasonality in all kinds of epidemics and pandemics.

Background: The physical decrements of aging predispose older adults to falls and fall-related injuries. Consequences of falling place financial and logistical burdens on the health care system. With an aging population, mitigation of risk and reduction of harm are important objectives. Studies show that exercise can improve balance and build muscle mass. The challenge is prescribing safe and evidence-based exercise regimens to older adults., Objectives: The objective of this evidence review was to determine if an exercise program can reduce fall rates and prolong functional independence among older adults living in the community., Data Sources: This review included 14 randomized control trials and one quasi-experimental interventional study, all published between 2014 and 2020., Conclusions: The evidence suggests that a home- or community-based exercise program with formal instruction and health care provider involvement can be an effective fall-prevention and harm reduction strategy for community-dwelling older adults., Implications for Practice: The evidence suggests that a home- or community-based exercise program may be an effective fall-prevention strategy for older adults living independently in the community. Health care providers should educate these patients about the benefits of exercise as a fall-prevention measure and assist patients in increasing participation in exercise programs by making referrals and promoting engagement in evidence-based exercise programs., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2021 American Association of Nurse Practitioners.)

Pathogen transfer and infection in the built environment are globally significant events, leading to the spread of disease and an increase in subsequent morbidity and mortality rates. There are numerous strategies followed in healthcare facilities to minimize pathogen transfer, but complete infection control has not, as yet, been achieved. However, based on traditional use in many cultures, the introduction of copper products and surfaces to significantly and positively retard pathogen transmission invites further investigation. For example, many microbes are rendered unviable upon contact exposure to copper or copper alloys, either immediately or within a short time. In addition, many disease-causing bacteria such as E. coli O157:H7, hospital superbugs, and several viruses (including SARS-CoV-2) are also susceptible to exposure to copper surfaces. It is thus suggested that replacing common touch surfaces in healthcare facilities, food industries, and public places (including public transport) with copper or alloys of copper may substantially contribute to limiting transmission. Subsequent hospital admissions and mortality rates will consequently be lowered, with a concomitant saving of lives and considerable levels of resources. This consideration is very significant in times of the COVID-19 pandemic and the upcoming epidemics, as it is becoming clear that all forms of possible infection control measures should be practiced in order to protect community well-being and promote healthy outcomes.

Objectives: To evaluate the potential of the automated titre score (TS) as an alternative method to continuous flow analysis (CFA) for the prediction of the nature of anti-D in pregnancy., Background: The 2016 revised British Society for Haematology (BSH) antenatal guidelines recommended a measurement of anti-D concentration by CFA to ensure the detection of potential immune anti-D. Due to high referral costs and resource pressures, uptake has been challenging for hospital laboratories. Serious Hazards of transfusion (SHOT) data have previously shown that this has contributed to missed antenatal follow ups for women with immune anti-D and neonates affected by haemolytic disease of the fetus/newborn., Methods/materials: In this multicentre comparative study, samples referred for CFA quantification were also tested by an ORTHO VISION automated anti-D indirect antiglobulin test (IAT) serial dilution and then converted to TS. CFA results and history of anti-D prophylaxis were used to categorise samples as passive or immune, with the aim of determining a potential TS cut-off for CFA referral of at risk patients., Results: Five UK National Health Service (NHS) trusts generated a total of 196 anti-D TS results, of which 128 were classified as passive and 68 as immune. Diagnostic testing of CFA and TS values indicated a TS cut-off of 35 to assist in distinguishing the nature of anti-D. Using this cut-off, 175 (89%) results were correctly assigned into the passive or immune range, giving a specificity of 92.19% and a negative predictive value of 91.47%., Conclusion: TS in conjunction with clinical and anti-D prophylaxis history can be used as a viable and cost-effective alternative to CFA in a hospital laboratory setting., (© 2020 The Authors. Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society.)

The foremost mortality-causing symptom associated with COVID-19 is acute respiratory distress syndrome (ARDS). A significant correlation has been identified between the deficiency in vitamin D and the risk of developing ARDS. It has been suggested that if we can reduce or modify ARDS in COVID-19 patients, we may significantly reduce the severity of COVID-19 symptoms and associated mortality rates. The increased mortality of dark-skinned people, who have a reduced UV absorption capacity, may be consistent with diminished vitamin D status. The factors associated with COVID-19 mortality, such as old age, ethnicity, obesity, hypertension, cardiovascular diseases, and diabetes, are all found to be linked with vitamin D deficiency. Based on this review and as a precautionary measure, it is suggested that the adoption of appropriate and safe solar exposure and vitamin D enriched foods and supplements should be considered to reduce the possible severity of COVID-19 symptoms. Safe sun exposure is deemed beneficial globally, specifically in low and middle-income countries, as there is no cost involved. It is also noted that improved solar exposure and vitamin D levels can reduce the impact of other diseases as well, thus assisting in maintaining general human well-being.

Bread wheat (Triticum aestivum L.) is one of the most important food crops, however it is only moderately tolerant to salinity stress. To improve wheat yield under saline conditions, breeding for improved salinity tolerance of wheat is needed. We have identified nine quantitative trail loci (QTL) for different salt tolerance sub-traits in a recombinant inbred line (RIL) population, derived from the bi-parental cross of Excalibur × Kukri. This population was screened for salinity tolerance subtraits using a combination of both destructive and non-destructive phenotyping. Genotyping by sequencing (GBS) was used to construct a high-density genetic linkage map, consisting of 3236 markers, and utilised for mapping QTL. Of the nine mapped QTL, six were detected under salt stress, including QTL for maintenance of shoot growth under salinity (QG(1-5).asl-5A, QG(1-5).asl-7B) sodium accumulation (QNa.asl-2A), chloride accumulation (QCl.asl-2A, QCl.asl-3A) and potassium:sodium ratio (QK:Na.asl-2DS2). Potential candidate genes within these QTL intervals were shortlisted using bioinformatics tools. These findings are expected to facilitate the breeding of new salt tolerant wheat cultivars.

Purpose: Open cranial vault remodeling (CVR) with autologous split calvarial bone grafts redistributes and recontours an abnormal calvarium to create an expanded cranial vault in patients with craniosynostosis. We report a 12-year retrospective review of 162 nonsyndromic patients who underwent operative repair using our previously-described technique which portends excellent surgical outcomes and can be applied to patients of any age group and with any variety of suture fusion., Methods: Data was gathered on patients who underwent CVR from 2005 to 2016. Surgical records for each patient were analyzed and included operative time, estimated blood loss, and intraoperative transfusion volumes. Intraoperative and postoperative complications, the need for revision surgery, postoperative length of stay, and follow-up records were also reviewed. Syndromic patients were excluded, as well as patients with incomplete data sets. Patients who underwent either anterior or posterior vault remodeling were compared., Results: A total of 162 patients were included in this case series. Patients undergoing anterior CVR were significantly older than those undergoing posterior CVR (13.3 versus 11.0 months, P < 0.015) and also had significantly greater intraoperative red blood transfusion volumes (20.3 versus 15.3cc/kg, P < 0.0207) and longer operative time than posterior CVR patients (274.9 versus 216.7 minutes, P < 0.0001). No patients required reoperation for resorption or recurrence or persistent contour irregularities. There were no visual or neurological complications. Calvarial bone was successfully split in 100% of cases., Conclusions: This surgical approach to CVR results in good surgical outcomes with a low recurrence rate, while also maximizing operative efficiency, and minimizing total blood loss and transfusion volume. This technique can be applied to any affected suture in a patient with craniosynostosis and in patients of any age group.

School-based social and emotional learning (SEL) programs can be effective in producing positive outcomes for students. However, when the implementation quality is poor, these programs often lose their effectiveness and fail to produce the expected positive outcomes. The current study evaluates a school-based SEL program for 15-18-year-olds in Ireland by determining the impact of implementation quality on program outcomes. The study also examines the effects on outcomes of different implementation dimensions including Dosage, Adherence, Quality of Delivery, and Participant Responsiveness. Employing a cluster randomized controlled trial design, this study collected student outcome data ( n = 675) from 32 disadvantaged schools across three time points (pre-, post-, 12-month follow-up) and compared these data across three treatment groups (high-implementation, low-implementation, and control). Linear mixed models (LMM) were used to determine the relationships between the implementation data and student outcome data longitudinally. The findings revealed that the positive effects of the program were only observed with the high-, but not the low-implementation group (reduced suppression of emotions ( p = 0.049); reduced avoidance coping ( p = 0.006); increased social support coping ( p = 0.009); reduced levels of stress ( p = 0.035) and depressive symptoms ( p = 0.025). The comparison of implementation dimensions revealed that only Quality of Delivery had a significant effect on all of the tested outcomes. This study highlights the importance of high-quality implementation in producing positive outcomes and supports the need to evaluate implementation using multiple dimensions.

School-based social and emotional learning (SEL) programs have been shown to be effective in producing positive outcomes for adolescents. However, variability in implementation quality can have a negative impact on these program effects. The aim of this current study is to examine the variability in implementation quality for schools implementing the MindOut program and to identify factors that were likely to contribute to this variability. Employing a mixed methods approach, quantitative and qualitative implementation data were collected from teachers (n = 16) and students (n = 280) who participated in the MindOut program. Quantitative indicators were used to score schools' implementation quality across four dimensions (dosage, adherence/fidelity, quality of delivery and participant responsiveness), and these were averaged to determine overall level of implementation (high/low). Qualitative data identified factors that contributed to implementation quality, and factors were then analyzed in accordance with the schools' implementation level grouping. Findings indicated that variability in implementation quality existed both between and within schools. A total of eight schools were assigned as high implementers and another eight as low implementers. Influencing factors were categorized into five themes: (i) program factors, (ii) participant factors, (iii) teacher factors, (iv) school contextual factors, and (v) organizational capacity factors. Several differences between high and low implementers were found in relation to these influencing factors. The findings contribute to the evidence on implementation quality in schools by advancing knowledge on measuring implementation quality across multiple dimensions and informants successfully. These findings can also inform practitioners of the main influencing factors in schools so that strategies can be developed to optimize implementation quality in the future.

Introduction: The endoscopic endonasal approach (EEA) provides visualization of four deep surgical corridors (transcribiform, transtubercular, transsellar, and transclival) with superior illumination and specialized deep-reaching instruments, as compared to microscopic techniques. Several studies have evaluated EEAs in children but do not stratify for the very young of age, whose particularly small nares and developmental anatomy may limit endonasal instrumentation., Methodology: A comprehensive review of EEAs in infants and children to age 4 was performed to determine the limitations in this age group., Results: Eighteen studies were identified describing this approach for pediatric patients and the surgical caveats and limitations were reviewed. In very small children, CSF leaks, meningioencephaloceles, tumors of the anterior skull base, and lesions at the rostral cervical spine have been successfully treated endonasally. While newer studies advocate using 2.7-mm diameter (18-cm length) lenses, 4-mm diameter rigid lenses have been used without technical difficulty. The youngest patient in whom an EEA was used was a 6-week-old for a dermoid resection. Some have advocated that due to the small nares, approaches via bilateral entry are optimal for multiple instruments, however, others, including authors of a series of 28 repaired CSF leaks demonstrate successful single nare access., Discussion: EEAs are associated with less blood loss, are less likely to hinder normal growth of the skull and midface, and allow for the resection of even malignant lesions. Despite the limitations of the frontal, ethmoid, and sphenoid sinuses before age 3, reports have not documented insurmountable difficulty with EEAs even in infants. 2.7-mm diameter endoscopes are favored unilaterally or bilaterally to treat both benign and malignant lesions and preserve the young patient's facial anatomy better than older methods. Ever improving technology has facilitated the use of this approach in patients it would otherwise be infeasible for in the past, but it still cannot overcome the anatomical constraints of certain young patients in which this approach remains unindicated. Patient selection is therefore of utmost importance and the risks and benefits of more extensive approaches in these cases must be considered.

The magnetic sensitivity of Hall-effect sensors made of InAlN/GaN and AlGaN/GaN heterostructures was measured between room temperature and 576 °C. Both devices showed decreasing voltage-scaled magnetic sensitivity at high temperatures, declining from 53 mV/V/T to 8.3 mV/V/T for the InAlN/GaN sample and from 89 mV/V/T to 8.5 mV/V/T for the AlGaN/GaN sample, corresponding to the decreasing electron mobility due to scattering effects at elevated temperatures. Alternatively, current-scaled sensitivities remained stable over the temperature range, only varying by 13.1% from the mean of 26.3 V/A/T and 10.5% from the mean of 60.2 V/A/T for the InAlN/GaN and AlGaN/GaN samples, respectively. This is due to the minimal temperature dependence of the electron sheet density on the 2-dimensional electron gas (2DEG). Both devices showed consistency in their voltage- and current-scaled sensitivity over multiple temperature cycles as well as nearly full recovery when returned to room temperature after thermal cycling. Additionally, an AlGaN/GaN sample held at 576 °C for 12 h also showed nearly full recovery at room temperature, further suggesting that GaN-based Hall-effect sensors are a good candidate for use in high temperature applications.

School-based social and emotional learning programs aim to provide students with the skills they need to deal with life challenges, thereby enhancing their social and emotional wellbeing, academic outcomes, and reducing their risk of mental health difficulties. While there is a robust evidence base on the effectiveness of these programs originating from the US, there is a relative paucity of research on how these programs impact young people in other county contexts, especially for older adolescents and those at higher risk. This study sets out to address this research gap by evaluating the effectiveness of a social emotional learning program designed for older adolescents in Ireland, the MindOut program. MindOut is a universal school-based social and emotional learning program designed for older adolescents in Ireland which was developed based on a common elements approach underpinned by CASEL's framework. Employing a cluster randomized-controlled trial, data on social and emotional skills, academic performance and mental health outcomes were collected from students (n = 497; 51.1% female) ages 15-18 years in 32 disadvantaged schools. There were significant improvements in intervention students' social and emotional skills including, reduced suppression of emotions (p = 0.035), use of more positive coping strategies [reduced avoidance coping p = < 0.001) and increased social support coping p = 0.044)]. Improvements in mental health and wellbeing were also found with significantly reduced levels of stress (p = 0.017) and depressive symptoms (p = 0.030) as well as reduced anxiety scores for females students (p = 0.044). These short-term evaluation findings support the positive impact of school-based social and emotional learning programs, such as MindOut, when designed to be both age and culturally appropriate and delivered to older adolescents in disadvantaged schools.