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Although the current rate of SARS-CoV-2 infections has decreased significantly, COVID-19 still ranks very high as a cause of death worldwide. As of October 2023, the weekly mortality rate is still at 600 deaths in the United States alone, which surpasses even the worst mortality rates recorded for influenza. Thus, the long-term outlook of COVID-19 is still a serious concern outlining the need for the next-generation vaccine. This study found that a prime/pull coronavirus vaccine strategy increased the frequency of functional SARS-CoV-2-specific CD4+ and CD8+ memory T cells in the lungs of SARS-CoV-2-infected triple transgenic HLA-DR*0101/HLA-A*0201/hACE2 mouse model, thereby resulting in low viral titer and reduced COVID-19-like symptoms.

Some of the largest scale chemical processes for the production of important commodity chemicals and fuels involve an H2-containing gas mixture as an intermediate [e.g. ammonia, urea, methanol, Fischer-Tropsch (F-T) diesel, and hydrotreatment of crude petroleum to refined fuels]. The successful development of a model H2-oxidizing chemoautotrophic host could expand the range of fuels and chemicals produced from H2 and CO2 intermediates in the chemical, oil, and gas sectors in the near term, as well as from renewable and waste-derived sources of these gases that are expected to greatly expand in coming years. Among non-photosynthetic bacteria that can utilize H2 and CO2, Cupriavidus necator (C. necator, formerly Ralstonia eutropha), is the best studied. C. necator is an excellent microbial host for the production of a variety of chemicals because it grows extremely quickly to very high cell densities autotrophically on H2 and CO2, is genetically tractable, and has the ability to accumulate polymers, such as polyhydroxybutyrate, at industrial levels. Despite having great potential as a platform bioproduction host, genetic tools are limited, making metabolic engineering of this organism slow and laborious. In this CRADA project, we developed a number of genetic tools for C. necator: 1) Improvement of C. necator genetic transformation efficiency2) Integration of heterologous genes into the C. necator chromosome and development of promoter library3) Development of graded RBSs to control heterologous protein expression4) Use of RBSs to demonstrate fatty alcohol production in C. necator5) Demonstration of CRISPR-Cas9 gene editing in C. necator

Building conditions, outdoor climate, and human behavior influence residential concentrations of fine particulate matter (PM2.5). To study PM2.5 spatiotemporal variability in residences, we acquired paired indoor and outdoor PM2.5 measurements at 3,977 residences across the United States totaling >10,000 monitor-years of time-resolved data (10-min resolution) from the PurpleAir network. Time-series analysis and statistical modeling apportioned residential PM2.5 concentrations to outdoor sources (median residential contribution = 52% of total, coefficient of variation = 69%), episodic indoor emission events such as cooking (28%, CV = 210%) and persistent indoor sources (20%, CV = 112%). Residences in the temperate marine climate zone experienced higher infiltration factors, consistent with expectations for more time with open windows in milder climates. Likewise, for all climate zones, infiltration factors were highest in summer and lowest in winter, decreasing by approximately half in most climate zones. Large outdoor-indoor temperature differences were associated with lower infiltration factors, suggesting particle losses from active filtration occurred during heating and cooling. Absolute contributions from both outdoor and indoor sources increased during wildfire events. Infiltration factors decreased during periods of high outdoor PM2.5, such as during wildfires, reducing potential exposures from outdoor-origin particles but increasing potential exposures to indoor-origin particles. Time-of-day analysis reveals that episodic emission events are most frequent during mealtimes as well as on holidays (Thanksgiving and Christmas), indicating that cooking-related activities are a strong episodic emission source of indoor PM2.5 in monitored residences.

Residential cooking can be a significant indoor source of odour, pollutants and particulate matter. Conventionally, range hoods expel the air into the ambient. A number of studies have investigated their contaminant capture performance. However, for highly energy efficient houses the installation of extracting range hoods can pose certain challenges, e.g. high ventilation losses, additional thermal bridges and potential air leakage sites. Therefore, the use of recirculation range hoods has become standard for highly energy efficient housing with mechanical ventilation with heat recovery in Central Europe.Open questions remain regarding their capture and filtration efficiency as a function of filter age, especially for particles and odours. But also, the actual energy savings potential when using recirculating instead of extracting devices in a highly energy efficient housing had not been documented yet. This paper addresses these questions with a literature review and an energetic comparison.The review identified a good number of studies which have investigated the capture performance of extracting range hoods with a focus on pollutants resulting from gas combustion and/or the cooking generated particles. These studies show that capture efficiency, in particular for front burner use, can vary drastically for different designs and that particle capture does not necessarily match capture efficiency for gaseous contaminants. No scientific study investigating the performance of recirculating range hoods was found. Tests for consumer magazines as well as surveys indicate notably lower performance compared to extracting hoods. In summary one can say that performance tests are urgently needed to quantify the capture and filter efficiency for particles and (odorous) organic compounds as a function of filter age.

Primary graft dysfunction (PGD) limits clinical benefit after lung transplantation, a life-prolonging therapy for patients with end-stage disease. PGD is the clinical syndrome resulting from pulmonary ischemia-reperfusion injury (IRI), driven by innate immune inflammation. We recently demonstrated a key role for NK cells in the airways of mouse models and human tissue samples of IRI. Here, we used 2 mouse models paired with human lung transplant samples to investigate the mechanisms whereby NK cells migrate to the airways to mediate lung injury. We demonstrate that chemokine receptor ligand transcripts and proteins are increased in mouse and human disease. CCR5 ligand transcripts were correlated with NK cell gene signatures independently of NK cell CCR5 ligand secretion. NK cells expressing CCR5 were increased in the lung and airways during IRI and had increased markers of tissue residency and maturation. Allosteric CCR5 drug blockade reduced the migration of NK cells to the site of injury. CCR5 blockade also blunted quantitative measures of experimental IRI. Additionally, in human lung transplant bronchoalveolar lavage samples, we found that CCR5 ligand was associated with increased patient morbidity and that the CCR5 receptor was increased in expression on human NK cells following PGD. These data support a potential mechanism for NK cell migration during lung injury and identify a plausible preventative treatment for PGD.

BACKGROUND: An unmet need exists to reliably predict the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) treated with oral anticoagulants (OACs). HYPOTHESIS: An externally validated model improves ICH risk stratification. METHODS: Independent factors associated with ICH were identified by Cox proportional hazard modeling, using pooled data from the GARFIELD-AF (Global Anticoagulant Registry in the FIELD-Atrial Fibrillation) and ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registries. A predictive model was developed and validated by bootstrap sampling and by independent data from the Danish National Patient Register. RESULTS: In the combined training data set, 284 of 53 878 anticoagulated patients had ICH over a 2-year period (0.31 per 100 person-years; 95% confidence interval [CI]: 0.28-0.35). Independent predictors of ICH included: older age, prior stroke or transient ischemic attack, concomitant antiplatelet (AP) use, and moderate-to-severe chronic kidney disease (CKD). Vitamin K antagonists (VKAs) were associated with a significantly higher risk of ICH compared with non-VKA oral anticoagulants (NOACs) (adjusted hazard ratio: 1.61; 95% CI: 1.25-2.08; p = .0002). The ability of the model to discriminate individuals in the training set with and without ICH was fair (optimism-corrected C-statistic: 0.68; 95% CI: 0.65-0.71) and outperformed three previously published methods. Calibration between predicted and observed ICH probabilities was good in both training and validation data sets. CONCLUSIONS: Age, prior ischemic events, concomitant AP therapy, and CKD were important risk factors for ICH in anticoagulated AF patients. Moreover, ICH was more frequent in patients receiving VKA compared to NOAC. The new validated model is a step toward mitigating this potentially lethal complication.

Pseudomonas putida have emerged as promising biocatalysts for the conversion of sugars and aromatic compounds obtained from lignocellulosic biomass. Understanding the role of carbon catabolite repression (CCR) in these strains is critical to optimize biomass conversion to fuels and chemicals. The CCR functioning in P. putida M2, a strain capable of consuming both hexose and pentose sugars as well as aromatic compounds, was investigated by cultivation experiments, proteomics, and CRISPRi-based gene repression. Strain M2 co-utilized sugars and aromatic compounds simultaneously; however, during cultivation with glucose and aromatic compounds (p-coumarate and ferulate) mixture, intermediates (4-hydroxybenzoate and vanillate) accumulated, and substrate consumption was incomplete. In contrast, xylose-aromatic consumption resulted in transient intermediate accumulation and complete aromatic consumption, while xylose was incompletely consumed. Proteomics analysis revealed that glucose exerted stronger repression than xylose on the aromatic catabolic proteins. Key glucose (Eda) and xylose (XylX) catabolic proteins were also identified at lower abundance during cultivation with aromatic compounds implying simultaneous catabolite repression by sugars and aromatic compounds. Reduction of crc expression via CRISPRi led to faster growth and glucose and p-coumarate uptake in the CRISPRi strains compared to the control, while no difference was observed on xylose+p-coumarate. The increased abundances of Eda and amino acid biosynthesis proteins in the CRISPRi strain further supported these observations. Lastly, small RNAs (sRNAs) sequencing results showed that CrcY and CrcZ homologues levels in M2, previously identified in P. putida strains, were lower under strong CCR (glucose+p-coumarate) condition compared to when repression was absent (p-coumarate or glucose only).IMPORTANCEA newly isolated Pseudomonas putida strain, P. putida M2, can utilize both hexose and pentose sugars as well as aromatic compounds making it a promising host for the valorization of lignocellulosic biomass. Pseudomonads have developed a regulatory strategy, carbon catabolite repression, to control the assimilation of carbon sources in the environment. Carbon catabolite repression may impede the simultaneous and complete metabolism of sugars and aromatic compounds present in lignocellulosic biomass and hinder the development of an efficient industrial biocatalyst. This study provides insight into the cellular physiology and proteome during mixed-substrate utilization in P. putida M2. The phenotypic and proteomics results demonstrated simultaneous catabolite repression in the sugar-aromatic mixtures, while the CRISPRi and sRNA sequencing demonstrated the potential role of the crc gene and small RNAs in carbon catabolite repression.

While a growing body of scientific literature describes the population health impacts of fossil fuelproduction and burning via climate and air pollution pathways, less is known about the healthimpacts of indoor combustion. This paper summarizes the results of studies from the last twodecades that investigated the association between exposure to sources of unvented combustionpollutants in homes and a range of health outcomes. We found gas combustion to be associatedwith 6-28% (95% confidence intervals) increased odds of asthma symptoms, 4-51% increasedodds of systemic symptoms, 7-81% increased odds of asthma medication use, and 3-12%increased risk of mortality. These findings can be used to improve public health, for example, byinforming requirements for improved ventilation and source control, justifying switching to ventedappliances, better regulation of device emissions and quantifying the benefits of electrificationof end-uses. Dose-response relationships between human health, NO2 exposure, and other by-products of combustion are not characterized with a high degree of precision. However, there isclear evidence of a wide range of health effects, even at low levels of exposure. Despite thevarious designs, geographic sites, length of follow-up, and study dates, we noted a level ofconsistency between the studies within the current meta-analysis, and with previous ones, whichstrengthens the level of confidence in our findings.

BACKGROUND: Engaging frontline clinicians and staff in quality improvement is a promising bottom-up approach to transforming primary care practices. This may be especially true in federally qualified health centers (FQHCs) and similar safety-net settings where large-scale, top-down transformation efforts are often associated with declining worker morale and increasing burnout. Innovation contests, which decentralize problem-solving, can be used to involve frontline workers in idea generation and selection. OBJECTIVE: We aimed to describe the ideas that frontline clinicians and staff suggested via organizational innovation contests in a national sample of 54 FQHCs. INTERVENTIONS: Innovation contests solicited ideas for improving care from all frontline workers-regardless of professional expertise, job title, and organizational tenure and excluding those in senior management-and offered opportunities to vote on ideas. PARTICIPANTS: A total of 1,417 frontline workers across all participating FQHCs generated 2,271 improvement opportunities. APPROACHES: We performed a content analysis and organized the ideas into codes (e.g., standardization, workplace perks, new service, staff relationships, community development) and categories (e.g., operations, employees, patients). KEY RESULTS: Ideas from frontline workers in participating FQHCs called attention to standardization (n = 386, 17%), staffing (n = 244, 11%), patient experience (n = 223, 10%), staff training (n = 145, 6%), workplace perks (n = 142, 6%), compensation (n = 101, 5%), new service (n = 92, 4%), management-staff relationships (n = 82, 4%), and others. Voting results suggested that staffing resources, standardization, and patient communication were key issues among workers. CONCLUSIONS: Innovation contests generated numerous ideas for improvement from the frontline. It is likely that the issues described in this study have become even more salient today, as the COVID-19 pandemic has had devastating impacts on work environments and health/social needs of patients living in low-resourced communities. Continued work is needed to promote learning and information exchange about opportunities to improve and transform practices between policymakers, managers, and providers and staff at the frontlines.

Reservoirs are ubiquitous water infrastructure, providing functional capability to manage, and often mitigate, hydrological variability across space and time. The presence and operation of a reservoir control the downstream flow regime, such that in many locations understanding reservoir operations is crucial to understanding the hydrological functioning of a catchment. Despite many advances in modelling reservoir operations, inclusion of reservoirs in large-scale hydrological modelling remains challenging, particularly when the number of reservoirs is large and data access is limited. Here we design a set of simple reservoir operating rules (with only two calibrated parameters) focused on simulating small water supply reservoirs across large scales with various types of open-access data (i.e. catchment attributes and flows at downstream gauges). We integrate our rules into a national-scale hydrological model of Great Britain and compare hydrological simulations with and without the new reservoir component. Our simple reservoir operating rules significantly increase model performance in reservoir-impacted catchments, particularly when the rules are calibrated individually at each downstream gauge. We also test the feasibility of using transfer functions (which transform reservoir and catchment attributes into operating rule parameters) to identify a nationally consistent calibration. This works well in ∼ 50 % of the catchments, while nuances in individual reservoir operations limit performance in others. We suggest that our approach should provide a lower benchmark for simulations in catchments containing water supply reservoirs and that more complex methods should only be considered where they outperform our simple approach.

Abstract Assessing pain in newborns in the NICU is crucial due to their frequent exposure to painful stimuli, yet it's challenging due to the subjective nature of current methods. This study aimed to evaluate the effectiveness of an AI system designed for automatic facial recognition by comparing its performance with the expert opinion of health care provider. This is a secondary analysis from an eye-tracking study, assessing neonatal pain evaluations by healthcare professionals. The performance of AI software, FaceReader 9, was compared to experts' evaluations using a visual-analog scale, focusing on identifying specific facial action units associated with different pain levels. The study found significant differences in AI-generated metrics—arousal and valence—across three stimulus types: non-noxious thermal, short-noxious, and prolonged-noxious, with p-values below 0.001. A strong correlation (r = 0.84, p ≤ .001) was observed between AI metrics and expert ratings. Eleven facial action units were identified as relevant to describe neonatal pain. The findings highlight the AI system's potential in accurately detecting and analyzing newborn facial expressions in response to varying pain intensities, demonstrating a significant correlation with healthcare professionals' assessments. This suggests that AI technology could enhance objective pain assessment in neonates.

Background: Dust generated during various wood-related activities, such as cutting, sanding, or processing wood materials, can pose significant health and environmental risks due to its potential to cause respiratory problems and contribute to air pollution. Understanding the factors influencing dust emission is important for devising effective mitigation strategies, ensuring a safer working environment, and minimizing environmental impact. This study focuses on developing an artificial neural network (ANN) model to predict dust emission values in the machining of black poplar (Populus nigra L.), oriental beech (Fagus orientalis L.), and medium-density fiberboards. Methods: The multilayer feed-forward ANN model is developed using a customized application built with MATLAB code. The inputs to the ANN model include material type, cutting width, number of blades, and cutting depth, whereas the output is the dust emission. Model performance is assessed through graphical and statistical comparisons. Results: The results reveal that the developed ANN model can provide adequate predictions for dust emission with an acceptable level of accuracy. Through the implementation of the ANN model, the study predicts intermediate dust emission values for different cutting widths and cutting depths, which are not considered in the experimental work. It is observed that dust emission tends to decrease with reductions in cutting width and cutting depth. Conclusion: This study introduces an alternative approach to optimize machining-process conditions for minimizing dust emissions. The findings of this research will assist industries in obtaining dust emission values without the need for additional experimental activities, thereby reducing experimental time and costs.

Abstract Hypophosphatemia (serum phosphate

Abstract Passive acoustic monitoring (PAM) has gained increasing popularity to study behaviour, habitat preferences, distribution and community assembly of birds and other animals. Automated species classification algorithms like ‘BirdNET’ are capable of detecting and classifying avian vocalizations within extensive audio data, covering entire species assemblages. PAM reveals substantial potential for biodiversity monitoring that informs evidence‐based conservation. Nevertheless, fully realizing this potential remains challenging, especially due to the issue of false‐positive species detections. Here, we introduce an optimized thresholding framework, which incorporates contextual information extracted from the time‐series of automated species detections (i.e. covariates on quality and quantity of species' detections measured at varying time intervals) to improve the differentiation of true and false positives. We verified a sample of BirdNET detections per species and modelled species‐specific thresholds using conditional inference trees. These thresholds were designed to minimize false‐positive detections while maximizing the preservation of true positives in the dataset. We tested this framework for a large dataset of BirdNET detections (5760 h of audio data, 60 sites) recorded over an entire breeding season. Our results revealed considerable interspecific variability of precision (percentage of true positives) within raw BirdNET data. Our optimized thresholding approach achieved high precision (≥0.9) for 70% of the 61 detected species, while species‐specific thresholds solely relying on the BirdNET confidence scores achieved high precision for only 31% of the species. Conservative universal thresholds (not species‐specific) reached high precision for 48% of the species. Our thresholding approach outperformed previous thresholding approaches and enhanced interspecific comparability for bird community analyses. By incorporating contextual information from the time‐series of species detections, the differentiation of true and false positives was substantially improved. Our approach may enhance a straightforward application of PAM in biodiversity research, landscape planning and evidence‐based conservation.

Abstract Occupational exposures in the large industrial mining sector contributed significantly to South Africa’s high excess death rate due to COVID-19. Historically poor work-protection oversight has perpetuated centuries of risky labor and living conditions within the industry, driving high levels of disease co-morbidities, and supporting enduring social vulnerabilities. In this paper, we offer a syndemic lens to consider the clustering of adversely interacting diseases among mineworkers in South Africa, drawing attention to the complex occupational health crisis and the need to move beyond simply reporting individual diseases or comorbidities among this population. The physically demanding and dangerous working conditions, the lack of adequate changes to crowded and unsanitary working and living situations, the failure to meet social and labor plan targets, the continued precarious nature of working contracts and mines, and the limited access to robust healthcare reflect the historically exploitative nature of industrial mining in South Africa that places miners at increased risk for various syndemics. This assessment of the adverse interactions of diseases and socioeconomic and political conditions highlights the need for focused research and more follow-through in comprehensive occupational reforms.

Abstract Background The International Federation for Emergency Medicine (IFEM) published its model curriculum for medical student education in emergency medicine in 2009. Because of the evolving principles of emergency medicine and medical education, driven by societal, professional, and educational developments, there was a need for an update on IFEM recommendations. The main objective of the update process was creating Intended Learning Outcomes (ILOs) and providing tier-based recommendations. Method A consensus methodology combining nominal group and modified Delphi methods was used. The nominal group had 15 members representing eight countries in six regions. The process began with a review of the 2009 curriculum by IFEM Core Curriculum and Education Committee (CCEC) members, followed by a three-phase update process involving survey creation [The final survey document included 55 items in 4 sections, namely, participant & context information (16 items), intended learning outcomes (6 items), principles unique to emergency medicine (20 items), and content unique to emergency medicine (13 items)], participant selection from IFEM member countries and survey implementation, and data analysis to create the recommendations. Results Out of 112 invitees (CCEC members and IFEM member country nominees), 57 (50.9%) participants from 27 countries participated. Eighteen (31.6%) participants were from LMICs, while 39 (68.4%) were from HICs. Forty-four (77.2%) participants have been involved with medical students’ emergency medicine training for more than five years in their careers, and 56 (98.2%) have been involved with medical students’ training in the last five years. Thirty-five (61.4%) participants have completed a form of training in medical education. The exercise resulted in the formulation of tiered ILO recommendations. Tier 1 ILOs are recommended for all medical schools, Tier 2 ILOs are recommended for medical schools based on perceived local healthcare system needs and/or adequate resources, and Tier 3 ILOs should be considered for medical schools based on perceived local healthcare system needs and/or adequate resources. Conclusion The updated IFEM ILO recommendations are designed to be applicable across diverse educational and healthcare settings. These recommendations aim to provide a clear framework for medical schools to prepare graduates with essential emergency care capabilities immediately after completing medical school. The successful distribution and implementation of these recommendations hinge on support from faculty and administrators, ensuring that future healthcare professionals are well-prepared for emergency medical care.

Abstract Biocrusts represent associations of lichens, green algae, cyanobacteria, fungi and other microorganisms, colonizing soils in varying proportions of principally arid biomes. The so-called grit crust represents a recently discovered type of biocrust situated in the Coastal Range of the Atacama Desert (Chile) made of microorganisms growing on and in granitoid pebbles, resulting in a checkerboard pattern visible to the naked eye on the landscape scale. This specific microbiome fulfills a broad range of ecosystem services, all probably driven by fog and dew-induced photosynthetic activity of mainly micro-lichens. To understand its biodiversity and impact, we applied a polyphasic approach on the phototrophic microbiome of this biocrust, combining isolation and characterization of the lichen photobionts, multi-gene phylogeny of the photobionts and mycobionts based on a direct sequencing and microphotography approach, metabarcoding and determination of chlorophylla+b contents. Metabarcoding showed that yet undescribed lichens within the Caliciaceae dominated the biocrust together with Trebouxia as the most abundant eukaryote in all plots. Together with high mean chlorophylla+b contents exceeding 410 mg m−2, this distinguished the symbiotic algae Trebouxia as the main driver of the grit crust ecosystem. The trebouxioid photobionts could be assigned to the I (T. impressa/gelatinosa) and A (T. arboricola) clades and represented several lineages containing five potential species candidates, which were identified based on the unique phylogenetic position, morphological features, and developmental cycles of the corresponding isolates. These results designate the grit crust as the only known coherent soil layer with significant landscape covering impact of at least 440 km2, predominantly ruled by a single symbiotic algal genus.

Background: Frailty is generally a marker of worse prognosis. The impact of frailty on both in-hospital and long-term outcomes in ST-segment-elevation myocardial infarction (STEMI) patients has not been well described. Given this context, we aimed to determine the prevalence and impact of frailty on in-hospital and 1-year outcomes in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Methods: This retrospective study reviewed STEMI patients aged ≥ 65 years who underwent pPCI at 1 of the 2 pPCI-capable hospitals at Vancouver Coastal Health. A frailty index (FI) was determined using a deficit-accumulation model, with those with an FI > 0.25 being defined as frail. The primary outcome was 1-year all-cause mortality. The secondary outcomes included in-hospital all-cause mortality, a composite of adverse in-hospital outcomes (all-cause mortality, cardiogenic shock, heart failure, reinfarction, major bleeding, or stroke), and the individual components of the composite. Results: A total of 1579 patients were reviewed, of which 228 (14.4%) were determined to be frail. After multivariable adjustment, greater frailty (ie, increasing FI) was associated with increased in-hospital all-cause mortality (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.50-2.35, P < 0.001), the composite adverse in-hospital outcome (OR, 1.46; 95% CI, 1.27-1.68, P < 0.001), and 1-year all-cause mortality (OR, 1.48; 95% CI, 1.10-2.00, P = 0.011). Conclusions: In a contemporary STEMI cohort of older patients receiving pPCI, 1 in 7 patients were frail, with greater frailty being independently associated with increased in-hospital and long-term adverse outcomes. These findings highlight the need for the early recognition of frailty and implementation of an interdisciplinary approach toward the management of frail STEMI patients. Résumé: Contexte: La fragilité est généralement un marqueur de mauvais pronostic. Les conséquences de la fragilité sur l’état de santé des patients hospitalisés et sur l’évolution de l’état de santé à long terme après un infarctus du myocarde avec élévation du segment ST (STEMI) ne sont pas bien établies. Nous avons donc cherché à déterminer la prévalence et les conséquences de la fragilité durant une hospitalisation et après un an chez des patients ayant eu un STEMI et devant subir une première intervention coronarienne percutanée (ICP). Méthodologie: Cette étude rétrospective visait à évaluer les patients de ≥ 65 ans ayant présenté un STEMI et ayant subi une première ICP dans l’un des deux hôpitaux de Vancouver Coastal Health capables d’effectuer une telle intervention. Un indice de fragilité a été établi à l’aide d’un modèle d’accumulation de déficit, les patients ayant un indice > 0,25 étant définis comme fragiles. Le critère d’évaluation principal était la mortalité toutes causes confondues après un an. Les critères d’évaluation secondaires comprenaient la mortalité toutes causes confondues à l’hôpital, un critère composé regroupant les résultats défavorables obtenus à l’hôpital (mortalité toutes causes confondues, choc cardiogénique, insuffisance cardiaque, nouvel infarctus, hémorragie majeure ou accident vasculaire cérébral) et les composants individuels du critère composé. Résultats: Au total, 1579 patients ont été évalués, dont 228 (14,4 %) ont été jugés fragiles. Après un ajustement à variables multiples, une plus grande fragilité (c.-à-d. une augmentation de l’indice de fragilité) était associée à une augmentation de la mortalité toutes causes confondues à l’hôpital (rapport de cote [RC] : 1,88; intervalle de confiance [IC] à 95 % : 1,50 à 2,35; p < 0,001), à des résultats défavorables obtenus à l’hôpital selon le critère composé (RC : 1,46; IC à 95 % : 1,27 à 1,68; p < 0,001) et à la mortalité toutes causes confondues après un an (RC : 1,48; IC à 95 % : 1,10 à 2,00; p = 0,011). Conclusions: Dans une cohorte contemporaine de patients âgés ayant présenté un STEMI et ayant subi une première ICP, un patient sur sept était fragile, une plus grande fragilité étant associée de manière indépendante à une augmentation des résultats défavorables à l’hôpital et à long terme. Ces résultats soulignent la nécessité de reconnaître rapidement la fragilité et de mettre en œuvre une approche interdisciplinaire pour prendre en charge les patients fragiles présentant un STEMI.

As one of the most popular websites in the world, Wikipedia’s success has long resided in the fact that anyone can contribute to this repository of human knowledge. However, behind this democratisation and wisdom-of-the-crowd initiative lie some entrenched inequalities and biases. MostWikipedia’s regular contributors are men from the Global North, which has led to much criticism and speculation. Consequently, the user-generated encyclopaedia has often been accused of both portraying women from a male perspective and downplaying their professional achievements. Against this background, this paper explores the narratives of six experienced female Latin and Ibero-American editors that have been actively involved in the translation of women’s biographies in the Spanish Wikipedia. Drawing on interpretative phenomenological analysis (IPA), this study seeks to ascertain the role of female editors-translators and how they perceive solidarity in the context of their work in the encyclopaedia. Our findings indicate that the participants view solidarity as a transformative activity whereby they collectively unite to promote equality, protect one another against harassment and oppression, and re-narrate women’s biographies. Moreover, although most participants did not identify as translators, translation was widely regarded as a means to increase the number of women’s articles on Wikipedia and help bridge the gender gap.

Abstract Currently, exchange of information between the geriatric clinic and the attending general practitioner (GP) occurs primarily through the doctor's letter after discharging from the clinic. The aim of our study was to reduce readmissions of multimorbid, geriatric patients to the clinic by establishing a new form of care via an electronic case file (ECF) and a consultation service (CS). The discharging geriatric clinic filled out an online ECF. The patient's GP should document quarterly follow-ups in the ECF. The case file was monitored by the discharging clinic due to a consultation service. The primary efficacy endpoint was the rehospitalization rate within one year. The hospitalization rate for patients managed in the project was 83.1/100 person years (PY), while the control group from insurance data had a rate of 69.0/100 PY. The primary endpoint did not show a statistically significant difference (p = 0.15). A total of 195 contacts were documented via CS for 171 participants, mostly initiated by the clinics. The clinical queries primarily concerned drug therapy. The Covid pandemic had an overall impact on hospitalizations. There are many approaches to reducing hospital readmissions after discharge of older patients. Supporting the transition from inpatient to outpatient care by different professional groups or care systems has been shown to have a positive effect. Furthermore, the utilisation of an ECF can also be beneficial in this regard.

Abstract COVID-19 disease is associated with a hyperinflammatory, pro-thrombotic state and a high mortality. Our primary objective was to assess the change in inflammatory and thrombotic markers associated with PEX, and secondary objectives were to assess the effects of PEX on progression of respiratory failure and incidence of acute thrombotic events. We conducted a prospective, phase II, non-blinded randomised control trial of plasma exchange compared to standard of care in critically ill adults with severe COVID-19 associated respiratory failure, requiring supplemental oxygen or ventilatory support and elevated thrombo-inflammatory markers (LDH, CRP, ferritin, and D-Dimer). Patients randomised to receive PEX were treated with a daily single volume plasma exchange for a minimum of five days. Twenty-two patients were randomised of who 11 received PEX. Demographic and clinical characteristics were similar between groups at presentation. PEX was associated with a significant reduction in pro-thrombotic markers FVIII, VWF and VWF Ag: ADAMTS 13 ratio (p 0.99) at 28 days. PEX successfully reduced pro-thrombotic markers, although was not associated with reduction in inflammatory markers, respiratory failure, or thrombotic events. Trial registration: (NCT04623255); first posted on 10/11/2020.

Abstract Background Residual fibroglandular breast tissue (RFGT) following a mastectomy is associated with the remaining of occult breast cancer at the time of mastectomy as well as an increased local recurrence risk thereafter. Despite its oncologic implications, data on measures to prevent RFGT are lacking. Therefore, in a first step knowledge of risk factors for RFGT is of uttermost importance in order to allow identification of patients at risk and subsequently adaption of the surgical treatment and potentially prevention of RFGT a priori. Methods We performed a systematic literature review in PubMed using the MESH terms [residual fibroglandular breast tissue], [residual breast tissue], [mastectomy] and [risk factor] followed by a retrospective data analysis including all patients with a mastectomy treated at the Department of Obstetrics and Gynecology of the Medical University of Vienna, Austria, between 01.01.2015 and 26.02.2020 in order to identify risk factors of RFGT following a mastectomy. The primary aim of the study was to assess a potential difference in RFGT volume between the different types of mastectomy. The secondary objectives of the study were to identify other potential risk factors for RFGT as well as to compare the skin and subcutaneous fat tissue thickness pre- to postoperatively. Results Significantly higher RFGT volumes were observed following a nipple-sparing mastectomy (NSM) compared to a skin-sparing mastectomy (SSM) and radical mastectomy (RME) (p

Climate change is expected to have major impacts on land surface and subsurface processes through its expression in the hydrological cycle, but the impacts to any particular basin or region are highly uncertain. Non-stationarities in the frequency, magnitude, duration, and timing of rainfall events have important implications for human societies, water resources, and ecosystems. The conventional approach for assessing the impacts of climate change is to downscale global climate model output and use it to drive regional and local models that express the climate within hydrology near the land surface. While this approach may be useful for linking global general circulation models to the regional hydrological cycle, it is limited for examining the details of hydrological response to climate forcing for a specific location over timescales relevant to decision-makers. For example, the management of a flood or a drought hazard requires detailed information that includes uncertainty based on the variability in storm characteristics rather than on the differences between models within an ensemble. To fill this gap, we present the second version of our STOchastic Rainfall Model (STORM), an open-source and user-friendly modelling framework for simulating a climatic expression as rainfall fields over a basin. This work showcases the use of STORM in simulating ensembles of realistic sequences, and spatial patterns of rainstorms for current climate conditions, and bespoke climate change scenarios that are likely to affect the water balance near the Earth's surface. We outline and detail STORM's new approaches as follows: one copula for linking marginal distributions of storm intensity and duration; orographic stratification of rainfall using the copula approach; a radial decay rate for rainfall intensity which takes into consideration potential, but unrecorded, maximum storm intensities; an optional component to simulate storm start dates and times via circular/directional statistics; and a simple implementation for modelling future climate scenarios. We also introduce a new pre-processing module that facilitates the generation of model input in the form of probability density functions (PDFs) from historical data for subsequent stochastic sampling. Independent validation showed that the average performance of STORM falls within 5.5 % of the historical seasonal total rainfall in the Walnut Gulch Experimental Watershed (Arizona, USA) that occurred in the current century.

The Early Learner Curriculum and Achievement Record (ELCAR, Greer et al., 2020) is a criterion-referenced curriculum and assessment of children's development of language and social repertoires from the earliest foundational observing responses to advanced verbal repertoires. The developmental cusps or stages identified in the ELCAR have been validated and replicated through rigorous single-subject studies, but the assessment's convergent and divergent validity with traditional psychometric measures of similar and dissimilar constructs have not been investigated. In the present study, we compared one component of the ELCAR, the Verbal Behavior Development Assessment--Revised (VBDA-R), to four traditional psychometric measures as well as observed joint attention between 42 mother-child dyads within a free play setting. The preschoolers attended a full day applied behavior analysis (ABA) school that served children with autism spectrum and related disorders. The VBDA-R demonstrated convergent validity with the Vineland Adaptive Behavior Scale--3 (Vineland-3) Teacher Rating Form Communication domain, Autism Diagnostic Observation Schedule--2 (ADOS-2) module, and observed child-initiated joint attention (IJA). It demonstrated divergent validity with the Sensory Experience Questionnaire (SEQ), Child Behavior Checklist externalizing scale (CBCL/1.5-5), and child response to mother-initiated joint attention (RJA).