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Abstract Magnetic resonance imaging offers unrivaled visualization of the fetal brain, forming the basis for establishing age-specific morphologic milestones. However, gauging age-appropriate neural development remains a difficult task due to the constantly changing appearance of the fetal brain, variable image quality, and frequent motion artifacts. Here we present an end-to-end, attention-guided deep learning model that predicts gestational age with R2 score of 0.945, mean absolute error of 6.7 days, and concordance correlation coefficient of 0.970. The convolutional neural network was trained on a heterogeneous dataset of 741 developmentally normal fetal brain images ranging from 19 to 39 weeks in gestational age. We also demonstrate model performance and generalizability using independent datasets from four academic institutions across the U.S. and Turkey with R2 scores of 0.81–0.90 after minimal fine-tuning. The proposed regression algorithm provides an automated machine-enabled tool with the potential to better characterize in utero neurodevelopment and guide real-time gestational age estimation after the first trimester.

Abstract Cryptosporidium, a protozoan pathogen, is a leading threat to public health and the economy. Herein, we report the development of a portable, colorimetric biosensing platform for the sensitive, selective and label/PCR-free detection of Cryptosporidium RNA using oligonucleotides modified gold nanoparticles (AuNPs). A pair of specific thiolated oligonucleotides, complementary to adjacent sequences on Cryptosporidium RNA, were attached to AuNPs. The need for expensive laboratory-based equipment was eliminated by performing the colorimetric assay on a micro-fabricated chip in a 3D-printed holder assembly. A smartphone camera was used to capture an image of the color change for quantitative analysis. The detection was based on the aggregation of the gold nanoparticles due to the hybridization between the complementary Cryptosporidium RNA and the oligonucleotides immobilized on the AuNPs surface. In the complementary RNA’s presence, a distinctive color change of the AuNPs (from red to blue) was observed by the naked eye. However, in the presence of non-complementary RNA, no color change was observed. The sensing platform showed wide linear responses between 5 and 100 µM with a low detection limit of 5 µM of Cryptosporidium RNA. Additionally, the sensor developed here can provide information about different Cryptosporidium species present in water resources. This cost-effective, easy-to-use, portable and smartphone integrated on-chip colorimetric biosensor has great potential to be used for real-time and portable POC pathogen monitoring and molecular diagnostics.

Despite the advances in engineered living materials (ELMs), the diversity of ELMs especially those that are capable of autonomous self-fabrication and regeneration, is low. Here, the authors engineer a resilient ELM biocomposite using Bacillus subtilis and secreted EutM proteins as selfassembling scaffold building blocks.

BackgroundAdequate self-care behaviour is essential for patients with a left ventricular assist device (LVAD) to prevent complications, prolong life, and optimise quality of life. However, there were no valid and reliable measurements available to assess self-care behaviour among patients with LVAD. We have previously developed the 33-item LVAD self-care behaviour scale.ObjectivesTo evaluate psychometric properties of the 33-item LVAD self-care behaviour scale.Methods and resultsData on 127 patients with a LVAD in Israel, Japan, and the USA were analysed (mean age 51±14.3, 81% male). Exploratory factor analysis extracted three factors, and 13 items were excluded from the scale. Internal consistency assessed by Cronbach's alpha was acceptable for the total scale (α = 0.80) and the three subscales: Factor 1: Monitoring (α = 0.81), Factor 2: Heart failure self-care (α = 0.67), and Factor 3: LVAD self-care (α = 0.63). The 20-item version of the LVAD self-care behaviour scale had sufficient convergent validity with another scale that assessed self-care related to the driveline of LVAD (r = 0.47, pConclusionsThe 20-item version of the LVAD self-care behaviour scale showed adequate validity and reliability. The scale is ready for use in clinical practice and research. Additional testing might further optimise the scale.

Memory-like responses in innate immune cells confer nonspecific protection against secondary exposures. A number of microbial agents have been found to induce enhanced or diminished recall responses in innate cells, however, studies investigating the ability of probiotic bacteria to trigger such effects are lacking. Here, we show that priming of human monocytes with a secretome from the gut probiotic bacterium Limosilactobacillus (L.) reuteri induces a mixed secondary response phenotype in monocyte-derived dendritic cells (mo-DCs), with a strong IL-6 and IL-1β response but low TNFα, IL-23 and IL-27 secretion. Instead, blood DC priming with L. reuteri-secretome resembles a tolerant state upon secondary exposure. A similar pattern was found in conventional and gut-like (retinoic acid exposed) DCs, although retinoic acid hampered TNFα and IL-6 production and enrichment of histone modifications in L. reuteri-secretome primed mo-DC cultures. Further, we show that the memory-like phenotype of mo-DCs, induced by priming stimuli, is important for subsequent T helper (Th) cell differentiation pathways and might determine the inflammatory nature of Th cells. We also show enhanced recall responses characterized by robust inflammatory cytokines and lactate production in the gut-like mo-DCs derived from β-glucan primed monocytes. Such responses were accompanied with enriched histone modifications at the promoter of genes associated with a trained phenotype in myeloid cells. Altogether, we demonstrate that a gut commensal-derived secretome prompts recall responses in human DCs which differ from that induced by classical training agents such as β-glucan. Our results could be beneficial for future therapeutic interventions where T cell responses are needed to be modulated.

Highly polarized, multi-kiloampere-current electron bunches from compact laser-plasma accelerators are desired for numerous applications. Current proposals to produce these beams suffer from intrinsic limitations to the reproducibility, charge, beam shape, and final polarization degree. In this paper, we propose colliding pulse injection (CPI) as a technique for the generation of highly polarized electron bunches from prepolarized plasma sources. Using particle-in-cell simulations, we show that colliding pulse injection enables trapping and precise control over electron spin evolution, resulting in the generation of high-current (multi-kA) electron bunches with high degrees of polarization (up to 95% for >2kA). Bayesian optimization is employed to optimize the multidimensional parameter space associated with CPI to obtain a percent-level energy spread, submicron normalized emittance electron bunches with 90% polarization using 100-TW class laser systems.

The length-weight relationship (LWR) and relative condition factor (Kn) are essential biometric tools in fishery studies since they provide information about the fish's growth, condition, and suitability in its habitat. The LWR of 680 samples of Selaroides leptolepis or yellowstripe scad collected from commercial trawls fishing in the Visayan Sea was studied to determine its growth condition. The results indicated that S. leptolepis exhibited an isometric growth (b = 3.023), indicating an equal growth rate of the fish's length size and body weight. The relative condition factor (Kn) values of the studied species fluctuated between 0.95 to 1.10 from November 2018 to October 2019 study period. The dry season had been observed that might influenced the Kn values 1, which indicated a state of well-being of yellowstripe scad during this season. The current study would provide baseline data about LWR and the relative condition factor of S. leptolepis in the Visayan Sea. These data are valuable for establishing a monitoring and management system for this fish species.

ObjectivesAutoimmune pancreatitis (AIP) is an increasingly recognized disease entity, but data in children are limited. AIP presentation and outcome in children might differ from the adult experience. We aim to determine the characteristic features of AIP in children.MethodsData about clinical symptoms, imaging, histology, and treatment were collected using two sources: (i) a systematic literature search and (ii) the INSPPIRE database, the largest international multicenter study of pancreatitis in children and the Cliniques Universitaires St-Luc (CUSL) registry.ResultsWe identified 48 AIP cases: 30 from literature review, 14 from INSPPIRE, and 4 from CUSL. The median age at diagnosis was 13 years (range 2-17 years). Abdominal pain (43/47, 91%) and/or obstructive jaundice (20/47, 42%) were the most common symptoms at diagnosis. Elevated serum IgG4 levels were only observed in 9/40 (22%) children. Cross-sectional imaging studies were abnormal in all children including hypointense global or focal gland enlargement (39/47, 83%), main pancreatic duct irregularity (30/47, 64%), and common bile duct stricture (26/47, 55%). A combination of lymphoplasmacytic inflammation, pancreatic fibrosis, and ductal granulocyte infiltration were the main histological findings (18/25, 72%). Children with AIP had a prompt clinical response to steroids. Complications of AIP included failure of exocrine (4/25, 16%) and endocrine (3/27, 11%) pancreas function.ConclusionsPediatric AIP has a distinct presentation with features similar to type 2 AIP in adults. This comprehensive report on the largest group of children with AIP to date is expected to help with the diagnosis and management of this disease and pave the way for future research studies.

ObjectiveThe aim of this study was to characterize utilization and benefit of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP).MethodsFrom August 2012 to February 2015, 301 children with ARP or CP were enrolled in the INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) study. Physicians reported utilization and benefit of therapeutic ERCP at enrollment. Differences were analyzed using appropriate statistical methods.ResultsOne hundred seventeen children (38.9%) underwent at least 1 therapeutic ERCP. The procedure was more commonly performed in children with CP compared with those with ARP (65.8% vs 13.5%, P < 0.0001). Utility of therapeutic ERCP was reported to be similar between ARP and CP (53% vs 56%, P = 0.81) and was found to be helpful for at least 1 indication in both groups (53/99 patients [53.5%]). Predictors for undergoing therapeutic ERCP were presence of obstructive factors in ARP and CP, Hispanic ethnicity, or white race in CP.ConclusionsTherapeutic ERCP is frequently utilized in children with ARP or CP and may offer benefit in selected cases, specifically if ductal obstruction is present. Longitudinal studies are needed to clarify the efficacy of therapeutic ERCP and to explore subgroups that might have increased benefit from such intervention.

El uso de compuestos químicos sintéticos para conservar alimentos o tratar enfermedades de origen bacteriano está limitado debido a que pueden ocasionar daños en la salud. Por ello, las industrias alimentaria y pecuaria buscan estrategias naturales para conservar alimentos y mantener la salud de los animales destinados a consumo humano. En este sentido, algunos extractos de plantas provenientes de Sonora, México podrían ser una alternativa debido a la gran diversidad de plantas y que algunas de ellas se utilizan tradicionalmente para tratar enfermedades. Por otro lado, son pocos los estudios que sustentan la actividad biológica de los extractos etanólicos de Gnaphalium oxyphyllum (E1) y Euphorbia maculata (E2). En este estudio, el contenido de fitoquímicos se determinó por espectrofotometría, la actividad antimicrobiana se determinó por difusión en agar y la actividad antioxidante se evaluó por ABTS, DPPH y FRAP. Los resultados mostraron que los extractos E1 y E2 presentaron fenoles totales, flavonoides totales, flavonas y flavonoles, flavanonas y dihidroflavonoles totales, así como, taninos totales, ácido clorogénico total y polisacáridos totales. Además, ambos extractos mostraron mayor actividad antimicrobiana contra Listeria monocytogenes ATCC 19115, Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922 y Salmonella entérica serovar Typhimurium ATCC 14028 cuando se utilizó 1 mg ml-1 (P

Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique developed to manage gastric outlet obstruction (GOO). It involves creating a fistula between the stomach and the proximal small bowel using an electric cautery-enhanced lumen-apposing metal stent (ECE-LAMS) with EUS guidance. We aimed to publish our experience in improving teaching of this technique to practicing endoscopists with a wide range of experience by comparing the outcomes before and after standardization of procedural steps. Methods All EUS-GEs performed for inoperable GOO at a single institution from 2014 to 2021 were retrospectively analyzed. The technique was taught by one experienced endoscopist with prior expertise. Five advanced endoscopists with prior EUS and ECE-LAMS placement experience participated. The impact of standardization on outcomes (clinical and technical success, length of stay [LOS], procedure time, and adverse events [AEs]) was compared. Results A total 41 EUS-GEs were performed (5 before and 36 after standardization) by endoscopists with practice experience ranging from 2 to 13 years. The patient population was similar in age and sex. Standardization was associated with significantly higher rates of technical success (100 % vs 60 %, P = 0.01) and lower peri-procedural AEs (2.8 % vs 40 %, P = 0.03). Two AEs in the pre-standardized group were gastric perforation and gastrocolic fistula creation. One AE in the post-standardized group was gastric perforation. Procedure time, clinical success, and LOS showed improvement, although it was not statistically significant. Conclusions Teaching EUS-GE after standardizing the procedure was associated with a significant increase in technical success and a decrease in AEs irrespective of prior total experiences.

External suspension from school is a common disciplinary practice in traditionally English-speaking countries. Few studies have sought student perceptions of school suspension, as well as measures of problem behaviours and emotional problems, and known factors that influence the development of antisocial behaviour, to examine associations between these variables. Three hundred and four adolescents, aged 12-17 years, from five schools in southern Australia completed a self-report questionnaire that asked about behavioural and mental health problems, and risk and protective factors known to be associated with suspension. Seventy-four of the participants had been previously suspended from school at least once. Having been previously suspended was associated with a greater level of problem behaviours and emotions, poor family management, low school commitment, reduced supportive teacher relationships, and interactions with antisocial peers. School suspension appears likely to be applied to students who lack the ability to self-regulate their behaviours and emotional problems in the classroom. By excluding students from school, pre-existing behavioural problems may be exacerbated by diminishing school protective factors and increasing exposure to known risk factors. Adolescents most at risk of being suspended would benefit from alternative school behaviour management policies and procedures that maintain the school as a protective factor.

La mastitis bovina es una enfermedad causada por bacterias patógenas que infectan la glándula mamaria del ganado lechero, lo cual genera pérdidas económicas importantes, además, debido al uso excesivo de antibióticos para tratar esta enfermedad, los microorganismos han creado resistencia a estos fármacos, por ello, se buscan nuevas alternativas para este fin. El objetivo fue evaluar el efecto antimicrobiano de extractos de plantas nativas de Sonora contra bacterias patógenas aisladas de vacas diagnosticadas con mastitis. Se obtuvieron 17 extractos etanólicos de plantas nativas de Sonora, y se evaluó su actividad antimicrobiana por el método de difusión en agar contra siete patógenos aislados de leche de vacas con mastitis utilizando una concentración de 50 mg/ml de cada extracto. El contenido de fenoles y flavonoides totales se determinó mediante espectrofotometría. Los resultados mostraron que los extractos de Ibervillea sonorae (wereke, tubérculo), Populus alba (álamo, hojas), Ambrosia ambrosioides (chicura, tallos), Krameria sonorae (cosahui, raíces) y Prosopis velutina (mezquite, hojas) fueron eficaces para eliminar a S. aureus, Streptococcus spp., E. coli, Enterobacter spp., Proteus spp., Shigella spp. y Citrobacter spp. (P

How do young children decide to trust testimony thatcontradicts their initial beliefs? The current study examinedwhether children rely on cues to informant credibility (i.e.,history of accuracy) to determine if they would endorse anunexpected label from an informant. Three- and 4-year-olds(N = 60) saw a picture of a hybrid artifact that consisted offeatures of two typical familiar artifacts. Children made initialjudgments about the name of the hybrid object andsubsequently received a different name offered by aninformant who had earlier either accurately or inaccuratelynamed familiar objects. Children were more willing to revisetheir own judgment and accept the unexpected label if it wasfrom a previously accurate informant than if it was fromsomeone who had made obvious naming errors. This suggeststhat preschool-aged children selectively revise their ownknowledge; they are more trusting toward sources provenaccurate than inaccurate.

Bilinguals’ need to monitor and inhibit non-relevantlanguages over a relevant one confers advantage in cognitivecontrol. No studies have demonstrated that the dual-languagecontrol process directly contributes to the bilingual cognitiveadvantage. We utilized a novel language control manipulationparadigm where 83 English-Chinese bilingual adultscompleted a reading and comprehension task in either single-language (low-language-control) or dual-language (high-language-control) prior to performing nonverbal executivecontrol tasks (Stroop, task-switching, and n-back). Resultsshowed that language control had significant effects onsubsequent cognitive performance, depending on whether theparticipants were regular dual language users or not. In thedual-language condition, but not the single-languagecondition, participants who used both languages regularlydemonstrated a smaller mixing cost in task-switching and agreater sensitivity in n-back detection compared toparticipants who did not. This suggests that dual languagecontrol utilizes similar resources as executive function andfrequent dual language use enhances this resource.

PurposeWe examined the relationship between glycemic control and urinary tract infections in women with type 1 diabetes mellitus.Materials and methodsWomen enrolled in the Epidemiology of Diabetes Interventions and Complications study, the observational followup of the Diabetes Control and Complications Trial, were surveyed to assess the rate of physician diagnosed urinary tract infections in the preceding 12 months. The relationship between glycated hemoglobin levels and number of urinary tract infections in the previous 12 months was assessed using a multivariable Poisson regression model.ResultsA total of 572 women were evaluated at year 17. Mean age was 50.7 ± 7.2 years, mean body mass index was 28.6 ± 5.9 kg/m(2), mean type 1 diabetes duration was 29.8 ± 5.0 years and mean glycated hemoglobin was 8.0% ± 0.9%. Of these women 86 (15.0%) reported at least 1 physician diagnosed urinary tract infection during the last 12 months. Higher glycated hemoglobin levels were significantly associated with number of urinary tract infections such that for every unit increase (1%) in recent glycated hemoglobin level, there was a 21% (p=0.02) increase in urinary tract infection frequency in the previous 12 months after adjusting for race, hysterectomy status, urinary incontinence, sexual activity in the last 12 months, peripheral and autonomic neuropathy, and nephropathy.ConclusionsThe frequency of urinary tract infections increases with poor glycemic control in women with type 1 diabetes. This relationship is independent of other well described predictors of urinary tract infections and suggests that factors directly related to glycemic control may influence the risk of lower urinary tract infections.

We examined whether persistence of epigenetic DNA methylation (DNA-me) alterations at specific loci over two different time points in people with diabetes are associated with metabolic memory, the prolonged beneficial effects of intensive vs. conventional therapy during the Diabetes Control and Complications Trial (DCCT) on the progression of microvascular outcomes in the long-term follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) Study. We compared DNA-me profiles in genomic DNA of whole blood (WB) isolated at EDIC Study baseline from 32 cases (DCCT conventional therapy group subjects showing retinopathy or albuminuria progression by EDIC Study year 10) vs. 31 controls (DCCT intensive therapy group subjects without complication progression by EDIC year 10). DNA-me was also profiled in blood monocytes (Monos) of the same patients obtained during EDIC Study years 16-17. In WB, 153 loci depicted hypomethylation, and 225 depicted hypermethylation, whereas in Monos, 155 hypomethylated loci and 247 hypermethylated loci were found (fold change ≥1.3; P < 0.005; cases vs. controls). Twelve annotated differentially methylated loci were common in both WB and Monos, including thioredoxin-interacting protein (TXNIP), known to be associated with hyperglycemia and related complications. A set of differentially methylated loci depicted similar trends of associations with prior HbA1c in both WB and Monos. In vitro, high glucose induced similar persistent hypomethylation at TXNIP in cultured THP1 Monos. These results show that DNA-me differences during the DCCT persist at certain loci associated with glycemia for several years during the EDIC Study and support an epigenetic explanation for metabolic memory.

In this paper, we present an unsupervised learning approach to identify the user points of interest (POI) by exploiting WiFi measurements from smartphone application data. Due to the lack of GPS positioning accuracy in indoor, sheltered, and high rise building environments, we rely on widely available WiFi access points (AP) in contemporary urban areas to accurately identify POI and mobility patterns, by comparing the similarity in the WiFi measurements. We propose a system architecture to scan the surrounding WiFi AP, and perform unsupervised learning to demonstrate that it is possible to identify three major insights, namely the indoor POI within a building, neighborhood activity, and micro mobility of the users. Our results show that it is possible to identify the aforementioned insights, with the fusion of WiFi and GPS, which are not possible to identify by only using GPS.

Abstract To estimate the risk of all‐cause mortality and hospitalization in frail patients with chronic heart failure (HF), a systematic search and meta‐analysis was carried out to identify all prospective cohort studies conducted among adults with HF where frailty was quantified and related to the primary endpoints of all‐cause mortality and/or hospitalization. Twenty‐nine studies reporting the link between frailty and all‐cause mortality in 18 757 patients were available for the meta‐analysis, along with 11 studies, with 13 525 patients, reporting the association between frailty and hospitalization. Frailty was a predictor of all‐cause mortality and hospitalization with summary hazard ratios (HRs) of 1.48 [95% confidence interval (CI): 1.31–1.65, P

In order to provide an emotionally responsive environment for young people in care, we must turn our attention to the emotional wellbeing of the adults who look after them. The COVID-19 pandemic provides an opportunity to highlight the importance of the emotional wellbeing of caring adults. This includes introducing processes within the workplace that can be adopted to support the development of self-care, such as developing skills in self-awareness, emotional literacy and regulation, enabling adults to be emotionally present and responsive to the needs of young people. This article reflects on the introduction of supervision, reflective practice and consultation within Aberlour Sycamore Services in Scotland, summarising a recent evaluation of these structures.

Colonization of the gastrointestinal tract with microorganisms during infancy represents a critical control point for shaping life-long immune-mediated disease susceptibility. Abnormal colonization or an imbalance of microbes, termed dysbiosis, is implicated in several diseases. Consequently, recent research has aimed at understanding ways to manipulate a dysbiotic microbiome during infancy to resemble a normal, healthy microbiome. However, one of the fundamental issues in microbiome research is characterizing what a “normal” infant microbiome is based on geography, ethnicity and cultural variations. This review provides a comprehensive account of what is currently known about the infant microbiome from a global context. In general, this review shows that the influence of cultural variations in feeding practices, delivery modes and hygiene are the biggest contributors to microbial variability. Despite geography or race, all humans have similar microbial succession during infancy.

El alto nivel de precariedad de la vivienda urbana es uno de los grandes retos que enfrentan las ciudades contemporáneas, especialmente en el sur global. Este problema requiere especial atención en Latinoamérica, donde, según los datos disponibles, en 2020 más del 23% de los habitantes de la región vivirán en barrios informales, y muchos de ellos en viviendas precarias. En este contexto es necesario imaginar soluciones para mitigar un problema que afecta a millones de habitantes urbanos. Teniendo en cuenta lo anterior, el proyecto SIMA explora aplicaciones de diseño y fabricación digital como aporte a la innovación en las prácticas de mejoramiento de vivienda. Con base en la identificación de los patrones y patologías recurrentes de la vivienda dirigida a sectores de bajos ingresos en Bogotá, el proyecto se piensa como un sistema combinatorio de diseño que permite resolver una serie indeterminada de proyectos de mejoramiento a partir del análisis de las posibles combinaciones entre las tipologías de vivienda identificadas y un número restringido de soluciones adecuadas a tales tipologías; lo anterior con el fin de ofrecer soluciones arquitectónicas eficientes y de calidad que ayuden a mejorar las condiciones de vida de los habitantes urbanos.

Foliar application of nitrogen (N) may supplement soil-applied N in sweet cherry orchards. The proteinogenic amino acid L-proline is a potential source of organic N. However, little is understood about its uptake and effects on fruit quality. In this study, 15N-labelled L-proline was spray-applied to branches of the cultivar ‘Lapins’ either pre- or post-harvest. Leaves, fruit, and whole branches were sampled to investigate the uptake and allocation of foliar-applied N. Both treatments resulted in elevated 15N levels in leaves, with N derived from proline (%NDP) comprising 0.22% and 0.45% after pre- and post-harvest applications, respectively. The fruit was a sink for pre-harvest L-proline, with the highest %NDP in the pedicel (0.21%), followed by the skin (0.17%) and flesh (0.12%). Quality outcomes of smaller, darker fruit with lower stem retention indicate advanced maturity following L-proline application. Both pre- and post-harvest treatments resulted in the recovery of 15N in branches at late dormancy, with %NDP in bark (0.12%), buds (0.15%), and wood (0.02%) of the post-harvest treatment twice as high compared with those from the pre-harvest treatment. This study demonstrates proof of concept of the uptake of L-proline into the leaves of sweet cherry plants and translocation into the fruit and storage organs of the branch.

Reducing food intake is a common host response to infection, yet it remains unclear whether fasting is detrimental or beneficial to an infected host. Despite the gastrointestinal tract being the primary site of nutrient uptake and a common route for infection, studies have yet to examine how fasting alters the host’s response to an enteric infection. To test this, mice were fasted before and during oral infection with the invasive bacterium Salmonella enterica serovar Typhimurium. Fasting dramatically interrupted infection and subsequent gastroenteritis by suppressing Salmonella’s SPI-1 virulence program, preventing invasion of the gut epithelium. Virulence suppression depended on the gut microbiota, as Salmonella’s invasion of the epithelium proceeded in fasting gnotobiotic mice. Despite Salmonella’s restored virulence within the intestines of gnotobiotic mice, fasting downregulated pro-inflammatory signaling, greatly reducing intestinal pathology. Our study highlights how food intake controls the complex relationship between host, pathogen and gut microbiota during an enteric infection. Author summary Most animals, including humans, lose their appetites when sick. Whether this sickness behavior has evolved as a protective mechanism is unclear. In addition, fasting therapies have become popular in recent years and show promise for treating chronic inflammatory diseases, but it is uncertain whether fasting-induced immunosuppression could leave an already fasted host more vulnerable to infection than a fed host. To test this, we fasted mice and orally infected them with the invasive bacterium Salmonella Typhimurium. This pathogen causes gastroenteritis (food poisoning) in humans and in antibiotic-pretreated mice. Notably, the fasted mice were protected from infection. While Salmonella rapidly expanded in the intestines of fed mice, their expansion was reduced in fasted mice. Moreover, Salmonella in the fasted mice did not cause any intestinal tissue damage as the bacteria were unable to invade the intestinal wall. This protection was found to be partially due to the gut microbiome, since fasting was unable to prevent Salmonella infection in mice lacking a microbiome, although the mice suffered less gastroenteritis. We therefore conclude that fasting can protect hosts from intestinal bacterial infections, in part through the actions of the gut microbiome.

Background/Aim: Endoscopic ultrasound (EUS) is a well-established tool used in the evaluation and treatment of a wide range of pathologies in adult medicine. EUS in pediatrics has been shown to be safe and technically effective, and its use continues to evolve. This article aims to describe the EUS experience at our tertiary-care centers with regard to safety, technical success, and its impact in clinical management. We also discuss the current and developing diagnostic and therapeutic uses for EUS in pediatrics such as in pancreaticobiliary disease, congenital anomalies, eosinophilic esophagitis, inflammatory bowel disease, and liver disease.Methods: This is a retrospective review of EUS performed by two pediatric gastroenterologists trained as endosonographers between April 2017 and November 2020. Patient demographics, procedure indication, procedure characteristics, technical success, and complications were collected. Literature review was performed to describe current and future uses of EUS in pediatrics.Results: Ninety-eight EUS were performed with 15 (15.3%) including fine needle aspiration/biopsy and 9 (9.2%) cases being therapeutic. Most common indications include choledocholithiasis (n = 31, 31.6%), pancreatic fluid collections (n = 18, 18.4%), chronic and acute recurrent pancreatitis (n = 14, 14.3%), and acute pancreatitis characterization (n = 13, 13.3%). Notable indications of pancreatic mass (n = 6, 6.1%) and luminal lesions/strictures (n = 6, 6.1%) were less common. Complications were limited with one instance of questionable GI bleeding after cystgastrostomy creation. Ninety-eight of 98 (100%) cases were technically successful.Conclusion/Discussion: EUS has been shown to be performed safely and successfully in the pediatric population by pediatric endosonographers. This study and review support its use in pediatric practice and demonstrate the wide variety of indications for EUS such as pancreatic cystgastrostomy, celiac plexus neurolysis, and evaluation of chronic pancreatitis. This literature review also demonstrates areas of potential development for EUS within the practice of pediatric gastroenterology.

This paper seeks to explain why the subject media studies looks and sounds the way it does today through the production of a genealogy of the subject. The questions addressed are first, why was this subject introduced into the curriculum in the 1970s? Secondly, how has knowledge in the subject been defined and contested, how and why has it changed in the course of the subject's history? Thirdly, which knowledge attains the status of truth and becomes the accepted definition of what the subject is about? The theoretical perspective adopted in this study draws from both postmodernist critiques and sociologies of subject knowledge. It presents a critical sociology of knowledge that draws insights from both social historians of school subjects and the work of Michel Foucault. The study draws a distinction between knowledge as defined by formal educational authorities (articulated in syllabuses) and knowledge defined by those practising the subject (teachers and curriculum advisors).

BACKGROUND: Treatment of heart failure (HF) is particularly complex in the presence of comorbidities. We sought to identify and associate comorbidity profiles with inpatient outcomes during HF hospitalizations. METHODS: Latent mixture modeling was used to identify common profiles of comorbidities during adult hospitalizations for HF from the 2009 Nationwide Inpatient Sample (n = 192,327). RESULTS: Most discharges were characterized by common comorbidities. A lifestyle profile was characterized by a high prevalence of uncomplicated diabetes, hypertension, chronic pulmonary disorders and obesity. A renal profile had the highest prevalence of renal disease, complicated diabetes, and fluid and electrolyte imbalances. A neurovascular profile represented the highest prevalence of cerebrovascular disease, paralysis, myocardial infarction and peripheral vascular disease. Relative to the common profile, the lifestyle profile was associated with a 15% longer length of stay (LOS) and 12% greater cost, the renal profile was associated with a 30% higher risk of death, 27% longer LOS and 24% greater cost, and the neurovascular profile was associated with a 45% higher risk of death, 34% longer LOS and 37% greater cost (all p

Background: Adults with heart failure (HF) experience a constellation of symptoms; however, understanding of gender differences in HF symptoms remain elusive. The aim of this study was to determine whether there are gender differences in physical and depressive symptoms and symptom patterns in HF using 2 different analytic techniques. Methods: We performed a secondary analysis of combined data from 6 studies of adults with HF. Physical symptoms were measured with the HF Somatic Perception Scale, and depressive symptoms were measured with the Patient Health Questionnaire-9. First, we performed propensity matching with the nearest neighbor to examine the average treatment effect for HF Somatic Perception Scale and Patient Health Questionnaire-9 in the matched sample of women and men. Next, we used the entire data set in a latent class mixture model to determine patterns of symptoms. Finally, we calculated predictors of class membership with multinomial logistic regression. Results: The sample (n = 524, 86.5% systolic HF) was 37% women with a mean age of 58.3 ± 13.9 years and mean number of years with HF of 6.9 ± 6.9. Three hundred sixty-six participants were matched on propensity scores; there were no significant gender differences in symptom scores between matched women (n = 183) and men (n = 183). Among all 524 participants, 4 distinct latent classes of symptom patterns indicate that many patients with HF are fatigued, some have more depressive symptoms, and others have significantly more edema or cough. Gender did not predict membership to any symptom pattern. Conclusions: There were significant gender differences in sociodemographics, health behaviors, and clinical characteristics, but not HF symptoms or symptom patterns, using either analytic technique. [ABSTRACT FROM AUTHOR]

With growing pressure on child and adolescent mental health teams to meet the needs of young people in care, alongside limited resources, there is an increasing need for care settings to consider their role in providing trauma-informed, healing care environments. This article describes the process of developing a therapeutic framework within a small residential care setting in Scotland. The framework encapsulates the importance of attending to the needs of the organisation as a whole in order to provide a safe, attuned and responsive environment, highlighting the fundamental layers of care necessary to provide a foundation upon which the healing journey can begin.

Optimizing the utilization of applied nitrogen (N) in fruit trees requires N supply that is temporally matched to tree demand. We investigated how the timing of N application affected uptake, allocation, and remobilization within 14-year-old “Gala”/M26 apple trees (Malus domestica Borkh) over two seasons. In the 2017–2018 season, 30 g N tree−1 of 5.5 atom% 15N–calcium nitrate was applied by weekly fertigation in four equal doses, commencing either 4 weeks after full bloom (WAFB) (pre-harvest) or 1-week post-harvest, or fortnightly, divided between pre- and post-harvest (50:50 split). Nitrogen uptake derived from fertilizer (NDF) was monitored by leaf sampling before whole trees were destructively harvested at dormancy of the first season to quantify N uptake and allocation and at fruit harvest of the second season to quantify the remobilization of NDF. The uptake efficiency of applied N fertilizer (NUpE) was significantly higher from pre-harvest (32.0%) than from the other treatments (~17%). The leaf NDF concentration, an indicator of N uptake, increased concomitantly only when pre-harvest N was applied. Pre-harvest treated trees allocated more than half of the NDF into fruit and leaves and stored the same amount of NDF into perennial organs as the post-harvest treatment. Subsequent spring remobilization of NDF was not affected by the timing of N fertigation from the previous season. A seasonal effect of remobilization was observed with a decrease in root N status and a reciprocal increase in branch N status at fruit harvest of season two. These findings represent a shift in the understanding of dynamics of N use in mature deciduous trees and indicate that current fertilizer strategies need to be adjusted from post-harvest to primarily pre-harvest N application to optimize N use efficiency. This approach can provide adequate storage N to support early spring growth the following season with no detriment to fruit quality.