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This review provides insights into the current research on pyrolytic bio-oil obtained from different feedstock regarding upgrading techniques and applications such as energy, fuels, chemicals, and carbon materials. Raw bio-oil is not appropriate for transportation and ignition due to undesired properties; therefore, several challenges have been reported regarding its suitable market application. For liquid biofuel production, thermochemical pathways, particularly hydrogenation and deoxygenation, must be carried out, and for chemical production, liquid solvents are mostly used via physical separation. The main issues related to downstream processes with environmental and economic assessment are also covered. The analysis indicates that the major bottlenecks for commercial applications of upgraded bio-oil are the initial stage (upgrading techniques), high production costs, and pilot scale production. Finally, future directions are addressed for the improvement of bio-oil upgrading.

The magnetic field range in which a magnetic sensor operates is an important consideration for many applications. Elliptical planar Hall effect (EPHE) sensors exhibit outstanding equivalent magnetic noise (EMN) on the order of pT/Hz, which makes them promising for many applications. Unfortunately, the current field range in which EPHE sensors with pT/Hz EMN can operate is sub-mT, which limits their potential use. Here, we fabricate EPHE sensors with an increased field range and measure their EMN. The larger field range is obtained by increasing the uniaxial shape-induced anisotropy parallel to the long axis of the ellipse. We present measurements of EPHE sensors with magnetic anisotropy which ranges between 12 Oe and 120 Oe and show that their EMN at 10 Hz changes from 800 pT/Hz to 56 nT/Hz. Furthermore, we show that the EPHE sensors behave effectively as single magnetic domains with negligible hysteresis. We discuss the potential use of EPHE sensors with extended field range and compare them with sensors that are widely used in such applications.

Background: Sensory information obtained from the visual, somatosensory, and vestibular systems is responsible for regulating postural control, and if damage occurs in one or more of these sensory systems, postural control may be altered. Objective: To evaluate and compare the postural sway velocity between children with normal hearing and with sensorineural hearing loss (SNHL), matched by sex and age group, and to compare the postural sway velocity between children with normal hearing and with SNHL, with and without vestibular dysfunction. Methods: Cross-sectional study that evaluated 130 children (65 with normal hearing and 65 with SNHL), of both sexes and aged between 7 and 11 years, from public schools of the city of Caruaru, Pernambuco state, Brazil. The postural sway velocity of the center of pressure (COP) was assessed by a force platform, in two directions, anteroposterior (AP) and mediolateral (ML)), in three positions, namely bipedal support with feet together and parallel (parallel feet (PF)), bipedal support with one foot in front of the other (tandem foot (TF)), and single-leg support (one foot (OF)), evaluated with the eyes open and closed. Results: Children with SNHL demonstrated greater postural sway velocity compared to children with normal hearing in all the positions evaluated, with significant differences in the AP direction, with the eyes open (PF: p = 0.001; TF: p = 0.000; OF: p = 0.003) and closed (PF: p = 0.050; TF: p = 0.005). The same occurred in the ML direction, with the eyes open (PF: p = 0.001; TF: p = 0.000; OF: p = 0.001) and closed (PF: p = 0.002; TF: p = 0.000). The same occurred in relation to vestibular function, where the children with SNHL with an associated vestibular dysfunction demonstrated greater postural sway velocity compared to children with normal hearing in all the positions evaluated, demonstrating significant differences in the AP direction, with the eyes open (TF: p = 0.001; OF: p = 0.029) and eyes closed (PF: p = 0.036; TF: p = 0.033). The same occurred in the ML direction, with the eyes open (TF: p = 0.000) and with the eyes closed (PF: p = 0.008; TF: p = 0.009). Conclusions: Children with SNHL demonstrated greater instability of postural control than children with normal hearing in all the directions assessed. Children with SNHL and an associated vestibular dysfunction demonstrated the greatest instability of postural control in this study.

Precise electrochemical machining (PECM) is being used increasingly to produce turbine blades (high-pressure compressors) from difficult-to-machine materials such as Inconel. However, the challenges associated with PECM are particularly pronounced for filigree workpieces characterized by high aspect ratios and thin-walled geometries. The need for high-pressure flushing within the working gap to renew the electrolyte poses a dilemma because it induces unwanted deflection in these thin-walled structures. This problem is intensified by the mechanical oscillation of the tool applied to promote flushing efficiency. The superposition of mechanical tool oscillation and turbulent flushing, which exacerbate fluid–structure interaction, has been identified as the essential cause of workpiece deflection. The aim of this paper is to present an experimental setup coupled with numerical methods to better investigate the phenomenon of workpiece deflection during PECM. In the first part of this work, a novel tool system for investigating the phenomenon of workpiece deflection in PECM is presented. The tool system combines typical PECM tool–workpiece arrangements for double-sided machining and a unique electrolytic mask that provides optical access to the working gap, allowing in situ measurements. After validating the tool system by experimental tests, the workpiece deflection is investigated using high-speed imaging. In a next step, analytical studies of the flushing conditions during machining operations are carried out. These investigations are followed by a structural investigation of the workpiece to improve the understanding of the deflection behavior of the workpiece. In addition, the effect on the blade tip caused by the continuously decreasing moment of inertia of the blade due to their thinning during machining is analyzed.

Spontaneous remissions (SRs) in blastic plasmacytoid dendritic cell neoplasms (BPDCNs) are infrequent, poorly documented, and transient. We report a 40-year-old man presenting with bycitopenia and soft tissue infection. The bone marrow exhibited 3% abnormal cells. Immunophenotyping of these cells revealed the antigens CD45+ (dim), CD34+, CD117+, CD123+ (bright), HLA-DR+ (bimodal), CD56+ (bright), CD33+, CD13+, CD2+, and CD22+ (dim) and the partial expression of the CD10+, CD36+, and CD7+ antigens. All other myeloid, monocytic, and lymphoid antigens were negative. Genetic studies showed a complex karyotype and mutations in the TP53R337C and KRASG12D genes. On hospital admission, the patient showed a subcutaneous nodule on the right hand and left lower limb. Flow cytometry multiparameter (FCM) analysis showed the presence of 29% abnormal cells with the previously described immunophenotype. The patient was diagnosed with BPDCN. The patient was treated with broad-spectrum antibiotics for soft tissue infection, which delayed therapy for BPDCN. No steroids or chemotherapeutic or hypomethylating agents were administered. His blood cell counts improved and skin lesions disappeared, until the patient relapsed five months after achieving spontaneous remission. About 60% of abnormal cells were identified. No changes in immunophenotype or the results of genetic studies were observed. The patient underwent a HyperCVAD chemotherapy regimen for six cycles. Consolidation therapy was performed via allogeneic bone marrow transplantation with an HLA-unrelated donor. One year after the bone marrow transplant, the patient died due to the progression of his underlying disease, coinciding with a respiratory infection caused by SARS-CoV-2. In the available literature, SRs are often linked to infections or other stimulators of the immune system, suggesting that powerful immune activation could play a role in controlling the leukemic clone. Nevertheless, the underlying mechanism of this phenomenon is not clearly understood. We hypothesize that the immune system would force the leukemic stem cell (LSC) to undergo a state of quiescence. This loss of replication causes the LSC progeny to die off, resulting in the SR of BPDCN.

Introduction: Global coronal alignment is mainly assessed by C7 plumbline and central sacral vertical line (CSVL), pelvic obliquity and shoulder alignment. A detailed analysis is mandatory when treating spinal deformity. It remains unclear to what extent mild scoliosis influences global coronal alignment. Research question: The objective was to define a comprehensive set of coronal alignment parameters and to investigate differences between individuals without spinal deformity and with mild scoliosis. The relationship between coronal and sagittal alignment and the influence of age were studied. Methods: Radiographs of 236 normal individuals (Group N) and 140 patients with scoliosis

BackgroundProlonged critical illness is often accompanied by an impairment of adrenal function, which has been frequently related to conditions complicating patient management. The presumed connection between hypoxia and the pathogenesis of this critical- illness- related corticosteroid insufficiency (CIRCI) might play an important role in patients with severe acute respiratory distress syndrome (ARDS). Since extracorporeal membrane oxygenation (ECMO) is frequently used in ARDS, but data on CIRCI during this condition are scarce, this study reports the behaviour of adrenal function parameters during oxygenation support with veno-venous (vv)ECMO in coronavirus disease 2019 (COVID-19) ARDS.MethodsA total of 11 patients undergoing vvECMO due to COVID-19 ARDS at the Medical University of Vienna, who received no concurrent corticosteroid therapy, were retrospectively included in this study. We analysed the concentrations of cortisol, aldosterone, and angiotensin (Ang) metabolites (Ang I–IV, Ang 1–7, and Ang 1–5) in serum via liquid chromatography/tandem mass spectrometry before, after 1 day, 1 week, and 2 weeks during vvECMO support and conducted correlation analyses between cortisol and parameters of disease severity.ResultsCortisol concentrations appeared to be lowest after initiation of ECMO and progressively increased throughout the study period. Higher concentrations were related to disease severity and correlated markedly with interleukin-6, procalcitonin, pH, base excess, and albumin during the first day of ECMO. Fair correlations during the first day could be observed with calcium, duration of critical illness, and ECMO gas flow. Angiotensin metabolite concentrations were available in a subset of patients and indicated a more homogenous aldosterone response to plasma renin activity after 1 week of ECMO support.ConclusionOxygenation support through vvECMO may lead to a partial recovery of adrenal function over time. In homogenous patient collectives, this novel approach might help to further determine the importance of adrenal stress response in ECMO and the influence of oxygenation support on CIRCI.

ObjectiveTo identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs.MethodsWe surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with ResultsWe excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup.ConclusionsIndividual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD.

IntroductionThe COVID-19 pandemic had a significant effect on influenza activity globally. In this study, we analyzed trends of influenza activity in 2020 during the COVID-19 pandemic in Ghana.MethodsThis was a cross-sectional study using active prospective influenza surveillance data from 29 sentinel sites. At the sentinel sites, we enrolled patients presenting with symptoms based on the WHO case definition for influenza-like illness (ILI) and severe acute respiratory illness (SARI). Oro and nasopharyngeal swabs were collected from patients and tested for the presence of influenza viruses using specific primers and probes described by the US-CDC. The percentage of positivity for influenza between 2017–2019 and 2021 was compared to 2020. Using the test for proportions in STATA 17.0 we estimated the difference in influenza activities between two periods.Results and discussionInfluenza activity occurred in a single wave during the 2020 surveillance season into 2021, September 28 2020–March 7 2021 (week 40, 2020–week 9, 2021). Influenza activity in 2020 was significantly lower compared to previous years (2017– 2019, 2021). Influenza A (H3) was more commonly detected during the early part of the year (December 30, 2019–March 8, 2020), while influenza B Victoria was more commonly detected toward the end of the year (September 28–December 28). In Ghana, adherence to the community mitigation strategies introduced to reduce transmission of SARS-CoV-2, which affected the transmission of other infectious diseases, may have also impacted the transmission of influenza. To the best of our knowledge, this is the first study in Ghana to describe the effect of the COVID-19 pandemic on influenza activity. The continuation and strict adherence to the non-pharmaceutical interventions at the community level can help reduce influenza transmission in subsequent seasons.

An observational methodology system has been designed which allows the observation and analysis of the technical-tactical behaviour and interaction of judokas during competition. The observation instrument (JUTACTIC) is composed of 8 fixed criteria that provide information related to the competition and the competitors and 13 variable criteria that, throughout the intrasessional monitoring of each combat, allow the behaviour displayed by both judokas and their interaction to be recorded. From an observational sample consisting of matches from the Rio 2016 Olympic champions and the corresponding samples made using the LINCE PLUS software, evidence of validity, reliability, generalizability and applicability of the observation system is provided. The content validity of the observation instrument has been endorsed by a panel of experts (n = 11). Intra and inter-observer reliability has been guaranteed from the results obtained in the Fleiss Kappa and the Krippendorff Alpha. The generalizability analysis with the design structure [Category] [Participants] / [Matches] has confirmed that around seven matches are needed to accurately analyse the behaviour of the competitor under study. The practical application possibilities of the observation instrument has been shown with an example of the results obtained and the regular behaviour structures detected (T-patterns) using the THEME software.

Background & Aims: There is limited information on how the liver-to-gut axis contributes to alcohol-associated liver disease (AALD). We previously identified that high-mobility group box-1 (HMGB1) undergoes oxidation in hepatocytes and demonstrated elevated serum levels of oxidized HMGB1 ([O] HMGB1) in alcoholic patients. Since interleukin-1 beta (IL-1B) increases in AALD, we hypothesized hepatocyte-derived [O] HMGB1 could interact with IL-1B to activate a pro-inflammatory program that, besides being detrimental to the liver, drives intestinal barrier dysfunction. Results: Alcohol-fed RageΔMye mice exhibited decreased nuclear factor kappa B signaling, a pro-inflammatory signature, and reduced total intestinal permeability, resulting in protection from AALD. In addition, [O] HMGB1 bound and signaled through the receptor for advanced-glycation end-products (RAGE) in myeloid cells, driving hepatic inflammation, intestinal permeability, and increased portal blood lipopolysaccharide in AALD. We identified that [O] HMGB1 formed a complex with IL-1B, which was found in the livers of patients with acute alcoholic hepatitis and mice with AALD. This complex originated from the liver, because it was absent in the intestine when hepatocytes did not produce [O] HMGB1. Mechanistically, the complex bound RAGE in Kupffer cells and macrophages induced a pro-inflammatory program. Moreover, it bound RAGE in intestinal macrophages and epithelial cells, leading to intestinal inflammation, altered intestinal epithelial cell tight junction protein expression, increased intestinal permeability, and elevated portal blood lipopolysaccharide, enhancing AALD pathogenesis. Conclusions: We identified a protein complex of liver origin that amplifies the pro-inflammatory feedback loop in AALD; therefore, targeting this complex could have significant therapeutic potential.

Research shows that one in five children will experience a concussion by age 16. Compared to adults, children experience longer and more severe postconcussive symptoms (PCS), with severity and duration varying considerably among children and complicating management of these patients. Persistent PCS can result in increased school absenteeism, social isolation, and psychological distress. Although early PCS diagnosis and access to evidence-based interventions are strongly linked to positive health and academic outcomes, symptom severity and duration are not fully explained by acute post-injury symptoms. Prior research has focused on the role of neuroinflammation in mediating PCS and associated fatigue; however relationship between inflammatory biomarkers and PCS severity, has not examined longitudinally. To identify which children are at high risk for persistent PCS and poor health, academic, and social outcomes, research tracking PCS trajectories and describing school-based impacts across the entire first year postinjury is critically needed. This study will 1) define novel PCS trajectory typologies in a racially/ethnically diverse population of 500 children with concussion (11-17 years, near equal distribution by sex), 2) identify associations between these typologies and patterns of inflammatory biomarkers and genetic variants, 3) develop a risk stratification model to identify children at risk for persistent PCS; and 4) gain unique insights and describe PCS impact, including fatigue, on longer-term academic and social outcomes. We will be the first to use NIH's symptom science model and patient-reported outcomes to explore the patterns of fatigue and other physical, cognitive, psychological, emotional and academic responses to concussion in children over a full year. Our model will enable clinicians and educators to identify children most at risk for poor long-term health, social, and academic outcomes after concussion. This work is critical to meeting our long-term goal of developing personalized concussion symptom-management strategies to improve outcomes and reduce disparities in the health and quality of life of children.

PurposeThe purpose of this case series is to report the surgical outcomes from the combination of a clear lensectomy, OMNI® canaloplasty, and a HYDRUS® microstent with an adjacent goniotomy.MethodsThis is a retrospective non-comparative single-center case series of four black patients of African descent with glaucoma who were treated with a clear lensectomy, OMNI canaloplasty, and a HYDRUS microstent with an adjacent goniotomy. The surgeries were performed by an experienced cataract and glaucoma surgeon, Daniel Laroche, MD. The parameters investigated in this study were postoperative intraocular pressure (IOP) and the mean number of preoperative and postoperative medications needed.ResultsThe mean age of the four patients was 44.5 years. All patients had a mean postoperative reduction in IOP of 17 mmHg to 12.7 mmHg. The mean number of preoperative medications was 2.2, while the mean number of postoperative medications was 0.3. Potential complications such as hyphema, IOP spikes, or corneal edema were not seen in this series. All patients achieved a lower IOP and stable vision with less refractive error. Patients also experienced improved visual fields, clearer vision, and more open angles.ConclusionClear lensectomy and combined microinvasive glaucoma surgery (MIGS) in patients with primary open-angle glaucoma (POAG) and narrow-angle glaucoma (NAG) results in the safe lowering of IOP. The limitations of this study include the small series size and the retrospective potential for bias. Further research with a larger series and a prospective trial with follow-up should be performed.

In this case series, we present a methodology for a proof of principle for the development of a unique biomarker for pigmentary glaucoma to detect progression before nerve fiber layer loss. Out of the five patients in this case series, one was excluded because of an outlier due to pseudoexfoliation syndrome with excessively dense pigmentation of the trabecular meshwork. The remaining patients displayed a decreased visual field loss with increased superior to inferior trabecular meshwork ratios. This methodology, though limited due to small sample size, shows that in a limited number of patients, visual field loss is positively correlated with increased superior to inferior trabecular meshwork ratios. The next steps would be to look at patients without glaucoma and patients with pigmentary glaucoma, along with complete inter-eye comparisons for patients with unilateral exfoliation syndrome to act as controls. To our knowledge, this is a novel methodology, and if the pattern holds, it can act as proof of principle for the development of a novel early biomarker for pigmentary glaucoma to improve early intervention and delay vision loss.

Cholera continues to cause many outbreaks in low and middle-income countries due to inadequate water, sanitation, and hygiene services. We describe a protracted cholera outbreak in Nairobi City County, Kenya in 2017. We reviewed the cholera outbreak line lists from Nairobi City County in 2017 to determine its extent and factors associated with death. A suspected case of cholera was any person aged >2 years old who had acute watery diarrhea, nausea, or vomiting, whereas a confirmed case was where Vibrio cholerae was isolated from the stool specimen. We summarized cases using means for continuous variables and proportions for categorical variables. Associations between admission status, sex, age, residence, time to care seeking, and outbreak settings; and cholera associated deaths were assessed using odds ratio (OR) with 95% confidence interval (CI). Of the 2,737 cholera cases reported, we analyzed 2,347 (85.7%) cases including 1,364 (58.1%) outpatients, 1,724 (73.5%) not associated with mass gathering events, 1,356 (57.8%) male and 2,202 (93.8%) aged ≥5 years, and 35 deaths (case fatality rate: 1.5%). Cases were reported from all the Sub Counties of Nairobi City County with an overall county attack rate of 50 per 100,000 people. Vibrio cholerae Ogawa serotype was isolated from 78 (34.8%) of the 224 specimens tested and all isolates were sensitive to tetracycline and levofloxacin but resistant to amikacin. The odds of cholera-related deaths was lower among outpatient cases (aOR: 0.35; [95% CI: 0.17-0.72]), age ≥5 years old (aOR: 0.21 [95% CI: 0.09-0.55]), and mass gathering events (aOR: 0.26 [95% CI: 0.07-0.91]) while threefold higher odds among male (aOR: 3.04 [95% CI: 1.30-7.13]). Nairobi City County experienced a protracted and widespread cholera outbreak with a high case fatality rate in 2017.

Este artículo describe y analiza algunas de las medidas de adaptación que fueron aplicadas por las instituciones de Educación y Formación Técnica Profesional (EFTP) de Costa Rica para hacer frente a los problemas y retos que surgieron durante la crisis sanitaria por el COVID-19. Al considerar que la EFTP tiene una orientación práctica y se enfoca en el desarrollo de habilidades para el trabajo, se investigó, desde un enfoque cualitativo, cuáles medidas de adaptación implementaron ante la pandemia el Instituto Nacional de Aprendizaje (INA), el Ministerio de Educación Pública (MEP), el Colegio Universitario de Cartago (CUC), el Colegio Universitario de Limón (CUNLIMÓN) y la Universidad Técnica Nacional (UTN), y cómo algunas de estas medidas podrían ser relevantes en escenarios pospandémicos. La recolección de los datos se realizó mediante entrevistas semiestructuradas aplicadas a las autoridades de las instituciones mencionadas en el año 2021 y el análisis de estos culminó en el 2023. Dentro de los resultados más relevantes se destaca que algunas de las acciones ejecutadas por los centros educativos estuvieron influenciadas, decisivamente, por las débiles condiciones de inversión educativa (presentes en el sistema, previo a la crisis sanitaria) y la disponibilidad de recursos para disminuir los efectos negativos de la pandemia. Las medidas para sostener las prácticas profesionales virtuales, así como la implementación de los currículos se convirtieron en unos de los principales retos por solucionar. En este contexto, las prácticas virtuales y algunas adaptaciones curriculares, específicamente, en evaluación y didáctica, fueron parte de las medidas implementadas durante la época de confinamiento por la pandemia.

This study evaluates the effects of pH levels and Zein/Gum Arabic (Z/GA) ratios on key encapsulation parameters of an anthocyanin-rich extract (ARE) derived from purple corn cob, using the antisolvent precipitation method. Parameters analyzed include encapsulation efficiencies for anthocyanins (%AEE) and polyphenols (%PEE), nanoparticle size, polydispersity index, ζ-potential, and thermal stability at 80 and 180 °C. Particles without GA showed poor stability and low %AEE, particularly at lower pH. Conversely, the addition of GA significantly enhanced encapsulation efficiency, especially under acidic conditions (pH 2–4), and improved the particle size uniformity. At Z/GA ratio of 1:1, GA played a crucial role in stabilizing nanoparticles, effectively preventing aggregation even when the net particle charge was near to zero. Characterization by SEM, FTIR and TGA confirmed the morphological, structural, and thermal properties of the encapsulated particles. Thermal stability tests demonstrated that encapsulated anthocyanins exhibited significantly improved resistance to thermal degradation, with half-life extended up to threefold compared to unencapsulated counterparts. These results highlight the potential of encapsulating ARE from purple corn cob in Z/GA matrices as a method to preserve anthocyanins functionality, improve their thermal stability during food processing, and enhance application in food systems. Additionally, this approach offers a sustainable alternative, adding value to agricultural by-products and promoting waste valorization in the food industry. However, further research on scalability, cost-effectiveness, and application in food processing systems are needed.

BackgroundNumerous mobile health apps are marketed globally, and these have specific features including physical activity tracking, motivational feedback, and recipe provision. It is important to understand which features individuals prefer and whether these preferences differ between consumer groups. ObjectiveIn this study, we aimed to identify consumers’ most preferred features and rewards for a mobile app that targets healthy eating and physical activity and to reduce the number of individual mobile health app features to a smaller number of key categories as perceived by consumers. In addition, we investigated the impact of differences in consumers’ BMI and self-efficacy on their intention to use and willingness to pay for such an app. Finally, we identified the characteristics of different target groups of consumers and their responses toward app features via cluster analysis. MethodsA total of 212 participants from France, Italy, the United Kingdom, and Germany were recruited via the web to answer questions about app features, motivation, self-efficacy, demographics, and geographic factors. It is important to note that our study included an evenly distributed sample of people in the age range of 23 to 50 years (23-35 and 35-50 years). The app features in question were generated from a 14-day cocreation session by a group of consumers from the United Kingdom and the Republic of Ireland. Results“Home work out suggestions,” “exercise tips,” and “progress charts” were the most preferred app features, whereas “gift vouchers” and “shopping discounts” were the most preferred rewards. “Connections with other communication apps” was the least preferred feature, and “charitable giving” was the least preferred reward. Importantly, consumers’ positive attitude toward the “social support and connectedness and mindfulness” app feature predicted willingness to pay for such an app (β=.229; P=.004). Differences in consumers’ health status, motivational factors, and basic demographics moderated these results and consumers’ intention to use and willingness to pay for such an app. Notably, younger and more motivated consumers with more experience and knowledge about health apps indicated more positive attitudes and intentions to use and willingness to pay for this type of app. ConclusionsThis study indicated that consumers tend to prefer app features that are activity based and demonstrate progress. It also suggested a potential role for monetary rewards in promoting healthy lifestyle behaviors. Moreover, the results highlighted the role of consumers’ health status, motivational factors, and socioeconomic status in predicting their app use. These results provide up-to-date, practical, and pragmatic information for the future design and operation of mobile health apps.

The activity-regulated cytoskeleton-associated protein (Arc/Arg3.1) is a neuron-specific immediate early gene (IEG) product. The protein regulates synaptic strength through modulation of spine density and morphology, AMPA receptor endocytosis, and as being part of a retrovirus-like inter-cellular communication mechanism. However, little is known about the detailed subsynaptic localization of the protein, and especially its possible presynaptic localization. In the present study, we provide novel electron microscopical data of Arc localization at hippocampal Schaffer collateral synapses in the CA1 region. The protein was found in both pre-and postsynaptic cytoplasm in a majority of synapses, associated with small vesicles. We also observed multivesicular body-like structures positive for Arc. Furthermore, the protein was located over the presynaptic active zone and the postsynaptic density. The relative concentration of Arc was 25% higher in the postsynaptic spine than in the presynaptic terminal. Notably, small extracellular vesicles labeled for Arc were detected in the synaptic cleft or close to the synapse, supporting a possible transsynaptic transmission of the protein in the brain.

The recent proliferation of environmental children’s literature and the growing interest in this type of books by researchers and proponents of ecocriticism could be deemed a byproduct of contemporary concerns regarding environmental sustainability. Considering books for children as more than mere tools for environmental awareness-raising prompts an approach to canonical picturebooks that reveals their ecocritical nature based on the esthetic, multimodal and literary dimensions of these works. This study proposes the analysis of 25 picturebooks by five influential female authors to identify the keys to their ecocritical reading. Indeed, the elements that define literary discourse construction in children’s books (paratextuality, illustration and design, character development and focalization) are precisely those that have proved to be fundamental in this sense. Interpreting these seminal works from an ecocritical vantage point updates them in step with current ecocentric paradigms by promoting a sense of wonder in young readers that leads them to delight in and reflect on nature and the environment.

Summary: Amphitropic proteins and peptides reversibly partition from solution to membrane, a key process that regulates their functions. Experimental approaches classically used to measure protein partitioning into lipid bilayers, such as fluorescence and circular dichroism, are hardly usable when the peptides or proteins do not exhibit significant polarity and/or conformational changes upon membrane binding. Here, we describe binding to lipid vesicles (B2LiVe), a simple, robust, and widely applicable nuclear magnetic resonance (NMR) method to determine the solution-to-membrane partitioning of unlabeled proteins or peptides. B2LiVe relies on previously described proton 1D-NMR fast-pulsing techniques. Membrane partitioning induces a large line broadening, leading to a loss of protein signals; therefore, the decrease of the NMR signal directly measures the fraction of membrane-bound protein. The method uses low polypeptide concentrations and has been validated on several membrane-interacting polypeptides, ranging from 3 to 54 kDa, with membrane vesicles of different sizes and various lipid compositions. Motivation: Characterization of the interaction of peptides and proteins with lipid membranes is relevant for the study of various biological processes and is often challenging for polypeptides, which do not possess intrinsic fluorophores and do not exhibit significant structural content changes, as well as for those characterized by low membrane affinities. To meet these challenges, we have developed a label-free 1D-1H-NMR-based experimental approach, named B2LiVe, to measure the binding of polypeptides to lipid vesicles. B2LiVe complements the arsenal of label-free biophysical assays available to characterize protein-membrane interactions.

Background Diadumene lineata is one of the most widespread sea anemone species worldwide. Although this species has been reported a few times on the Argentine coast since 2004, its identification has traditionally been based on external morphological characteristics, and in most cases no voucher specimens are available to support previous records. Methods In this study, we obtained DNA sequences of two mitochondrial markers (12S and 16S) and two nuclear markers (18S and 28S) from specimens of D. lineata collected in two locations on the Argentine coast separated by almost 800 km. Additionally, we conducted an analysis of the morphology, as well as the types and size ranges of cnidae, using specimens collected at three different locations along the Argentine coast. Furthermore, since introduced populations of D. lineata are presumably ephemeral and only reproduce asexually outside their native range, we examined the internal anatomy of representatives from the Argentine coast for gametogenic tissue as an indication of whether they might be capable of sexual reproduction. Results DNA data support our morphological identification, including cnidae analyses, of the specimens as D. lineata. Furthermore, all specimens examined were determined to be sterile. Discussion Genetic sequence comparisons, phylogenetic reconstruction, and cnidae data support the identification of individuals of D. lineata from Mar Chiquita and Garipe Beach, confirming the presence of the species on the Argentine coast using both morphological and molecular tools. The absence of fertile specimens suggests that each sampled population is likely reproducing only by asexual reproduction and possibly composed of clones. The presence of an additional category of longer p-mastigophores B2a in the actinopharynx and filaments, as well as holotrichs in the column, is also reported. Conclusions For the first time, we have confirmed the presence of D. lineata in Argentina through molecular data. Additionally, our findings indicate that the analyzed specimens are sterile, suggesting that this species is not engaging in sexual reproduction in the studied localities. It is crucial to continue monitoring the populations of D. lineata along the Argentine coast to assess whether they establish sexual reproduction, expand their distribution range or disappear, or potentially cause any harm to local species or alterations in benthic communities.

IntroductionGene expression is often controlled via cis-regulatory elements (CREs) that modulate the production of transcripts. For multi-gene genetic engineering and synthetic biology, precise control of transcription is crucial, both to insulate the transgenes from unwanted native regulation and to prevent readthrough or cross-regulation of transgenes within a multi-gene cassette. To prevent this activity, insulator-like elements, more properly referred to as transcriptional blockers, could be inserted to separate the transgenes so that they are independently regulated. However, only a few validated insulator-like elements are available for plants, and they tend to be larger than ideal.MethodsTo identify additional potential insulator-like sequences, we conducted a genome-wide analysis of Utricularia gibba (humped bladderwort), one of the smallest known plant genomes, with genes that are naturally close together. The 10 best insulator-like candidates were evaluated in vivo for insulator-like activity.ResultsWe identified a total of 4,656 intergenic regions with expression profiles suggesting insulator-like activity. Comparisons of these regions across 45 other plant species (representing Monocots, Asterids, and Rosids) show low levels of syntenic conservation of these regions. Genome-wide analysis of unmethylated regions (UMRs) indicates ~87% of the targeted regions are unmethylated; however, interpretation of this is complicated because U. gibba has remarkably low levels of methylation across the genome, so that large UMRs frequently extend over multiple genes and intergenic spaces. We also could not identify any conserved motifs among our selected intergenic regions or shared with existing insulator-like elements for plants. Despite this lack of conservation, however, testing of 10 selected intergenic regions for insulator-like activity found two elements on par with a previously published element (EXOB) while being significantly smaller.DiscussionGiven the small number of insulator-like elements currently available for plants, our results make a significant addition to available tools. The high hit rate (2 out of 10) also implies that more useful sequences are likely present in our selected intergenic regions; additional validation work will be required to identify which will be most useful for plant genetic engineering.

Abstract Background The coronavirus pandemic has had a profound impact on organization and delivery of care. The challenges faced by healthcare organizations in dealing with the pandemic have intensified interest in the concept of resilience. While effort has gone into conceptualising resilience, there has been relatively little work on how to evaluate organizational resilience. This paper reports on an extensive review of approaches to resilience measurement and assessment in empirical healthcare studies, and examines their usefulness for researchers, policymakers and healthcare managers. Methods Various databases (MEDLINE, EMBASE, PsycINFO, CINAHL (EBSCO host), Cochrane CENTRAL (Wiley), CDSR, Science Citation Index, and Social Science Citation Index) were searched from January 2000 to September 2021. We included quantitative, qualitative and modelling studies that focused on measuring or qualitatively assessing organizational resilience in a healthcare context. All studies were screened based on titles, abstracts and full text. For each approach, information on the format of measurement or assessment, method of data collection and analysis, and other relevant information were extracted. We classified the approaches to organizational resilience into five thematic areas of contrast: (1) type of shock; (2) stage of resilience; (3) included characteristics or indicators; (4) nature of output; and (5) purpose. The approaches were summarised narratively within these thematic areas. Results Thirty-five studies met the inclusion criteria. We identified a lack of consensus on how to evaluate organizational resilience in healthcare, what should be measured or assessed and when, and using what resilience characteristic and indicators. The measurement and assessment approaches varied in scope, format, content and purpose. Approaches varied in terms of whether they were prospective (resilience pre-shock) or retrospective (during or post-shock), and the extent to which they addressed a pre-defined and shock-specific set of characteristics and indicators. Conclusion A range of approaches with differing characteristics and indicators has been developed to evaluate organizational resilience in healthcare, and may be of value to researchers, policymakers and healthcare managers. The choice of an approach to use in practice should be determined by the type of shock, the purpose of the evaluation, the intended use of results, and the availability of data and resources.

Abstract Background There is an emerging consensus that point-of-care ultrasound is an essential skill in acute care. This is reflected in recent changes to the Acute Internal Medicine curriculum in the UK. The need to develop and maintain specific ultrasound competencies is now a mandatory component of training. There is a degree of uncertainty as to how existing training infrastructure can best accommodate these changes. Methods Data were obtained from the latest annual Society for Acute Medicine Benchmarking Audit 2021. All Acute Medical Units in the UK are eligible to participate. Data pertaining to the number of ultrasound machines and number of clinicians that regularly use point of care ultrasound were collected. This was used to develop a series of maps demonstrating variation in provision at the national level. Results In total, 123 AMUs responded to the questions related to ultrasound prevalence and numbers of trained clinicians. Of these, 78.9% (97/123) reported having access to at least one ultrasound machine. There was at least one clinician that regularly used ultrasound in 81 responding hospitals (65.9%). There was significant geographic heterogeneity in the use of ultrasound and availability of accredited supervisors. At a regional level, ultrasound expertise is typically concentrated within a relatively small number of hospitals. Conclusion Geographic variation in the use of ultrasound and availability of registered supervisors represents a significant challenge to ultrasound training provision at the national level. Targeted interventions in areas with less developed training infrastructure, such as regional training hubs may be required to ensure more equitable access to training opportunities.

Abstract Landfills will likely remain an essential part of integrated solid waste management systems in many developed and developing countries for the foreseeable future. Further improvements are required to model the generated gas from landfills. The literature has not addressed detailed waste characterization in landfill gas (LFG) modeling by a first-order decay model such as LandGEM while using a genetic algorithm. Additionally, little has been done in the literature regarding H2S generation modeling. This paper uses a genetic algorithm to independently fit parameters to a CH4 and H2S generation model based on a modified first-order decay model. In the case of CH4 generation modeling, biodegradable organic waste (OW) was segregated into food waste, yard waste, paper, and wood. In addition to optimizing the OW fractions, key modeling parameters of OW, such as CH4 generation potential ( $${L}_{0}$$ L 0 ) and CH4 decay rate ( $${k}_{C{H}_{4}}$$ k C H 4 ), were determined independently for different periods in the landfill’s life. Similarly, in the case of H2S generation modeling, the construction and demolition waste (CD) was classified into fines (FCD) and bulky materials (BCD), and H2S generation potential ( $${S}_{0}$$ S 0 ) and H2S decay rate ( $${k}_{{H}_{2}S}$$ k H 2 S ) of FCD and BCD were determined. LFG collection data from a landfill site in the province of Quebec, Canada, was used to validate the LFG generation model. A range of scenarios was analyzed using the validated model, including fourteen scenarios (two benchmark and twelve optimizing) for CH4 and two for H2S modeling. The results showed that the differentiation of more waste types improves the modeling accuracy for CH4. Moreover, within the decade-long lifetime of a landfill, the waste management strategies change, requiring different assumptions for the modeling. Also, the work showed the importance of considering how different landfill sectors are filled over time. Finally, scenario twelve of optimizing scenarios, which assumed four waste types, constant three periodic waste fractions, and six sectors, had the lowest residual sum of squares (RSS) value. For H2S generation modeling, both scenarios, with or without separate fits of $${S}_{0}$$ S 0 and $${k}_{{H}_{2}S}$$ k H 2 S for FCD and BCD, predicted the generated H2S well and had a very similar RSS value. Further data could improve H2S generation modeling.

The primary aim of the presented paper is the identification of barriers to knowledge sharing by scientific R&D project team members in a Czech academic environment. In order to fulfill this aim, secondary analysis was used to process the literature search in the context of the problem being solved, and qualitative and quantitative research in the form of a structured interview and a questionnaire survey were used to identify the barriers to knowledge sharing by scientific R&D project team members. The essential output of the presented paper is the identification of barriers to knowledge sharing by members of the scientific R&D project team in Czech public and private universities and the discussion of their causes and impacts in scientific R&D projects. With regard to the aim of the presented paper and the formulated research questions, our effort is that the presented discussion outputs are not only academic considerations but scientific analyses and outputs capable of concrete life. Above all, we propose an innovation of Riege's model of barriers to knowledge sharing, as it was chosen as a comparative basis for our research; however, it was found that it is not applicable in the current conditions of scientific R&D project management in the Czech academic environment. Doi: 10.28991/HIJ-2023-04-01-02 Full Text: PDF

This study investigates the correlates of statistics anxiety. Considering that statistics anxiety and spatial anxiety have been separately correlated with related constructs (e.g., mathematics anxiety, academic performance, etc.), the possibility that spatial anxiety plays a role in statistics anxiety is explored. When facing statistics or mathematics operations, people may imagine or visualize the task operations they must do to obtain the result. To examine this hypothesis, 778 students in a Social or Health Sciences program, enrolled in a –often mandatory– statistics course from Canadian, French and Belgian universities completed an online survey. The results show moderate to strong positive correlations between all three types of anxiety (spatial, mathematics, and statistics). In addition, a mediation analysis reveals the intermediate role played by mathematics anxiety in the relationship between spatial and statistics anxieties. Nonetheless, the direct link from spatial anxiety to statistics anxiety is non-negligible in the model. Finally, the results also indicate that women report higher levels of statistics anxiety, which may be partly explained by their higher level of spatial anxiety.

Abstract Objectives To investigate the association between assisted reproductive technology (ART) use and childhood cancer subtype. Study Design We deployed a cross‐sectional survey of 1701 parents of children with cancer about their ART use, demographics, and gestational and perinatal factors. Multivariable logistic regression modeled the association between ART use, birthweight and multiple gestation status with childhood cancer, by subtype. Results ART use was highest among children with osteosarcoma relative to children with other cancer types, and this association was statistically significant in multivariable models (OR = 4.4; 95% CI = 1.7–11.3; p = 0.0020). ART use was also elevated among children with hepatoblastoma, but this relationship appeared to be due to the strong associations between ART use and lower birthweight in our sample. No specific ART modality appeared to drive these associations. In univariate models, multiple gestation was associated with a 2.7‐fold increased odds of hepatoblastoma (OR = 2.71; 95% CI = 1.14–6.42; p = 0.02) and a 1.6‐fold increased odds of neuroblastoma (OR = 1.62; 95% CI = 1.03–2.54; p = 0.03), but these associations were not retained in multivariable models. Conclusions Associations between ART use and hepatoblastoma risk may be attributable to birthweight, a known hepatoblastoma risk factor. ART use may also be associated with osteosarcoma, independent of birthweight, an association not previously observed in studies limited to cancers diagnosed before adolescence. Evaluating long‐term health outcomes in children conceived by ART, throughout adolescence and potentially into adulthood, appears warranted.

Background In 2011, the European Commission adopted the European framework for the National Roma Integration Strategies (NRISs) 2020, which focussed on four areas: education, employment, health and housing. In 2012 Spain approved its Strategy 2012–20, one of the central aims of which is to reduce social inequalities in health that affect the Roma population. Our objective was to analyze changes in health inequalities between the Roma population and the general population in Spain in the years 2006 and 2014. Methods The Spanish National Health Surveys (NHSs) 2006 (n  = 29 478) and 2012 (n  = 20 884) and the NHS of the Spanish Roma Population 2006 (n  = 933) and 2014 (n  = 1155) were compared. This study considered the variables included in NRIS 2012–20: self-perceived health, tobacco use in men, traffic accidents in men and women, obesity in women and gynaecological visits. Results Despite the adoption of the NRIS 2012–20, there were no observed improvements in health between 2006 and 2014 in the Roma population. Nor was there a reduction in inequalities in health concerning the general population in Spain. Also, there was no reduction in the health inequalities by gender for the two populations. Conclusions Health is determined in part by social factors including education, employment, housing and also by anti-Roma discourses and discrimination. Improving the health of the Roma population requires a multi-sectoral approach with a gender perspective. [ABSTRACT FROM AUTHOR]

Background and Purpose: Breast intra operative radiation therapy has been evaluated with different systems delivering 20–21 Gy with treatment times around 30 min. Papillon + TM Contact X-ray machine was designed to produce a 50 kVp beam with a high dose rate ≥ 15 Gy/minute. A pilot study with the first prototype was conducted in Nice. Materials and methods: The inclusion criteria were age ≥ 60 years, unifocal ductal breast adenocarcinoma ≤ 2.5 cm, grade 1–2. Surgical local excision with sentinel node dissection was performed and the applicator was placed in the tumor bed after excision with a prescribed dose of 20 Gy. The main end point of the study was the doses measured with the Gafchromic films; two were located at the skin surface and two in the excision cavity. Secondary endpoints were early toxicity and relapse free survival. Results: Between 10/2018 and 09/2019, 26 patients were included. Mean Gafchromic doses were 18.8 Gy ± 2 Gy at the south pole, 15.6 Gy ± 2.81 Gy at the equator and 2.5 Gy ± 1.67 Gy at the skin. With a median follow-up time of 12 months, no skin or subcutaneous toxicity > grade 2, no local relapse and no metastasis were observed. Conclusion: This is the first phase II study testing the Papillon + tm system for breast IORT with in vivo dosimetry measurements and reassuring clinical data.

Este estudio tenía como objetivo determinar las demandas cinemáticas, cinéticas y la frecuencia cardíaca del balonmano playa femenino de élite, diferenciando partidos oficiales y no oficiales. Catorce jugadoras (60.0 ± 4.1 kg; 168.5 ± 5.9 cm; 24.6 ± 4.0 años) de la Selección Española Absoluta de Balonmano Playa fueron monitorizadas durante once partidos previos al Campeonato del Mundo 2018. La carga externa se obtuvo mediante el uso del dispositivo GPS y la carga interna, mediante la frecuencia cardíaca a través de una banda torácica. La distancia recorrida por las jugadoras por set en los partidos oficiales (PO) fue mayor (334.79 ± 135.41 m) en comparación con los partidos de entrenamiento (PE) (324.97 ± 90.88 m) y con los partidos amistosos (PA) (263.52 ± 133.92 m), siendo las diferencias significativas (p < .001) entre los PO y los PA. Ocurre de igual forma en la Vmáx registrada en los PO (14.00 ± 2.68 km·h-1) frente a los PA (13.47 ± 2.33 km·h-1). Existieron diferencias significativas (p < .05) entre los PO y los PA tanto en aceleraciones como en desaceleraciones en la Zona 2 (2 a 3 m·s-2) y fue el segundo set el que reportó mayor número de aceleraciones y desaceleraciones. En los PE, el segundo set mostró un menor número de aceleraciones y desaceleraciones dado que se obtuvo un mayor nivel de fatiga. Por tanto, los PO tuvieron una mayor demanda cinemática y cinética que los PE y los PA. Pero es en los PE donde se registra un mayor nivel de fatiga.

Matrix stiffening is a quintessential feature of aged tissues. Authors show that an aged (stiff) matrix epigenetically represses the gene encoding the longevity factor, α-Klotho, resulting in chondrocyte dysfunction, a leading cause of osteoarthritis.

Abstract Background Implementing Point-of-care ultrasound (POCUS) in community practice could help to decide upon and prioritise initial treatment, procedures and appropriate specialist referral or conveyance to hospital. A recent literature review suggests that image quality, portability and cost of ultrasound devices are all improving with widening indications for community POCUS, but evidence about community POCUS use is needed in the UK. We aimed to explore views of clinical practitioners, actively using ultrasound, on their experiences of using POCUS and potential facilitators and barriers to its wider implementation in community settings in the UK. Methods We conducted a qualitative interview study with practitioners from community and secondary care settings actively using POCUS in practice. A convenience sample of eligible participants from different clinical specialties and settings was recruited using social media adverts, through websites of relevant research groups and snowball sampling. Individual semi-structured interviews were conducted online using Microsoft Teams. These were recorded, transcribed verbatim, and analysed using a Framework approach supported by NVivo 12. Results We interviewed 16 practitioners aged between 40 and 62 years from different professional backgrounds, including paramedics, emergency physicians, general practitioners, and allied health professionals. Participants identified key considerations and facilitators for wider implementation of POCUS in community settings in the UK: resource requirements for deployment and support of working devices; sufficient time and a skilled workforce; attention to training, education and support needs; ensuring proper governance, guidelines and quality assurance; workforce considerations; enabling ease of use in assisting decision making with consideration of unintended consequences; and more robust evidence to support perceptions of improved patient outcomes and experience. Conclusions POCUS could be useful for improving patient journey and health outcomes in community care, but this requires further research to evaluate outcomes. The facilitators identified could help make community POCUS a reality.

In recent years, social research surrounding the consequences of infertility has increasingly focused on the male perspective; however, a gap exists in the understanding of men's experiences of male infertility treatment. This review aims to synthesize the existing evidence concerning the psychological, social, and sexual burden of male infertility treatment on men, as well as patient needs during clinical care. A systematic search identified 12 studies that are diverse in design, setting, and methods. Psychological evaluations have found that urological surgery may have a lasting impact on infertility-specific stress, and treatment failure can lead to feelings of depression, grief, and inadequacy. Men tended to have an avoidant coping mechanism throughout fertility treatment, and their self-esteem, relationship quality, and sexual functions can be tied to outcomes of treatment. Partner bonds can be strengthened by mutual support and enhanced communication; couple separation, however, has been noted as a predominant reason for discontinuing male infertility treatment and may be associated with difficult circumstances surrounding severe male infertility. Surgical treatments can affect the sexual functioning of infertile men; however, the impact of testicular sperm extraction outcomes appears to be psychologically driven whereas the improvements after microsurgical varicocelectomy are only evident in hypogonadal men. Clinically, there is a need for better inclusion, communication, education, and resource provision, to address reported issues of marginalization and uncertainty in men. Routine psychosocial screening in cases of severe male infertility and follow-up in cases of surgical treatment failure are likely beneficial.

This research examines the connection between higher education curricula for sustainable development and student development of key competencies for sustainability. The authors conducted a comparative case study that followed ten students from three graduate sustainability programs. Through a combination of student-generated and contextual data, we created a set of learning journeys. These journeys showed that activities which foster reflection, interaction, and real-world connections are especially critical for competence development as part of the whole curriculum. What and how students found most useful depended on individual disposition and we identified four general categories based on prior experience, attitude to learning, and individual goals. Barriers to competency development were frustration, feelings of helplessness, and being unable to link competence to concrete activities or concepts. These barriers could be mitigated through peer interaction and mentorship, environmental support such as spaces for collaboration, and instructor scaffolding. Because no single course can fit the needs of each student, we recommend that beneficial components in the form of courses that support the above-mentioned activities be part of purposeful curriculum design.

Abstract The manufacturing processes of electrical machines may lead to significant degradation of the magnetic properties of their magnetic core (stator, rotor) performances and, as a consequence, to a decrease of their energy efficiency. While the effects of some processes (cutting, welding …) are widely discussed in the literature, this is not the case with the compaction process although it is systematically used to maintain the assembly of electrical steel sheets that compose the magnetic circuits. In addition to the conventional one, a specific compaction process exists for high-power electrical machines. After an introduction, the paper firstly deals with the two studied processes (conventional, specific). Then, an experimental mock-up to study the impact of the two configurations on the magnetic properties (iron losses, normal magnetization curve) is presented. This mock-up is the first, in the literature, that allows to study the effect of a controlled compaction mechanical stress on magnetic properties. Obtained results in both configurations highlight a magneto-mechanical effect that is not reported in the literature where these effects are commonly considered following in-plane mechanical stresses. This paper presents a magneto-mechanical model, taking into account the compaction stress effect, as well as a modelling protocol to model the effect of 3D mechanical stress on magnetic properties, which has never been done in the literature.

OBJECTIVES:. To develop proof-of-concept algorithms using alternative approaches to capture provider sentiment in ICU notes. DESIGN:. Retrospective observational cohort study. SETTING:. The Multiparameter Intelligent Monitoring of Intensive Care III (MIMIC-III) and the University of California, San Francisco (UCSF) deidentified notes databases. PATIENTS:. Adult (≥18 yr old) patients admitted to the ICU. MEASUREMENTS AND MAIN RESULTS:. We developed two sentiment models: 1) a keywords-based approach using a consensus-based clinical sentiment lexicon comprised of 72 positive and 103 negative phrases, including negations and 2) a Decoding-enhanced Bidirectional Encoder Representations from Transformers with disentangled attention-v3-based deep learning model (keywords-independent) trained on clinical sentiment labels. We applied the models to 198,944 notes across 52,997 ICU admissions in the MIMIC-III database. Analyses were replicated on an external sample of patients admitted to a UCSF ICU from 2018 to 2019. We also labeled sentiment in 1,493 note fragments and compared the predictive accuracy of our tools to three popular sentiment classifiers. Clinical sentiment terms were found in 99% of patient visits across 88% of notes. Our two sentiment tools were substantially more predictive (Spearman correlations of 0.62–0.84, p values < 0.00001) of labeled sentiment compared with general language algorithms (0.28–0.46). CONCLUSION:. Our exploratory healthcare-specific sentiment models can more accurately detect positivity and negativity in clinical notes compared with general sentiment tools not designed for clinical usage.

Background Unilateral diaphragm dysfunction (UDD) is an underdiagnosed cause of dyspnoea. Inspiratory muscle training (IMT) is the only conservative treatment for UDD, but the mechanisms of improvement are unknown. We characterised the effects of IMT on dyspnoea, exercise tolerance and respiratory muscle function in people with UDD. Methods 15 people with UDD (73% male, 61±8 years) were randomised to 6 months of IMT (50% maximal inspiratory mouth pressure (PI,max), n=10) or sham training (10% PI,max, n=5) (30 breaths twice per day). UDD was confirmed by phrenic nerve stimulation and persisted throughout the training period. Symptoms were assessed by the transitional dyspnoea index (TDI) and exercise tolerance by constant-load cycle tests performed pre- and post-training. Oesophageal (Pes) and gastric (Pga) pressures were measured with a dual-balloon catheter. Electromyography (EMG) and oxygenation (near-infrared spectroscopy) of respiratory muscles were assessed continuously during exercise. Results The IMT group (from 45±6 to 62±23% PI,max) and sham group (no progression) completed 92 and 86% of prescribed sessions, respectively. PI,max, TDI scores and cycle endurance time improved significantly more after IMT versus sham (mean between-group differences: 28 (95% CI 13–28) cmH2O, 3.0 (95% CI 0.9–5.1) points and 6.0 (95% CI 0.4–11.5) min, respectively). During exercise at iso-time, Pes, Pga and EMG of the scalene muscles were reduced and the oxygen saturation indices of the scalene and abdominal muscles were higher post- versus pre-training only in the IMT group (all p

Question Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers.Study selection and analysis Three randomised trials were identified with 1795 individual participant data (IPD). We performed an IPD meta-analysis to estimate the effects of SH+, primarily on depressive symptoms and second on post-traumatic stress, well-being, self-identified problems and functioning. Effects were also estimated at 5–6 months postrandomisation (midterm).Findings There was no evidence of a difference between SH+ and ECAU+ in reducing depressive symptoms at postintervention. However, SH+ had significantly larger effects among participants who were not employed (β=1.60, 95% CI 0.20 to 3.00) and had lower mental well-being levels (β=0.02, 95% CI 0.001 to 0.05). At midterm, SH+ was significantly more effective than ECAU in improving depressive symptoms (β=−1.13, 95% CI −1.99 to −0.26), self-identified problems (β=−1.56, 95% CI −2.54 to −0.59) and well-being (β=6.22, 95% CI 1.60 to 10.90).Conclusions Although SH+ did not differ significantly from ECAU in reducing symptoms of depression at postintervention, it did present benefits for particularly vulnerable participants (ie, unemployed and with lower mental well-being levels), and benefits were also evident at midterm follow-up. These results are promising for the use of SH+ in the management of depressive symptoms and improvement of well-being and self-identified problems among refugees and asylum seekers.

Background: Objectives: Study established factors associated with SAM among children aged 6 months to 59 months attending Moroto Regional Referral Hospital. The specific objectives of the study were to assess demographic, socioeconomic, and clinical factors associated with SAM among children aged 6-59 months attending MRRH, Moroto municipality in the Karamoja sub-region. Methodology: The study used a descriptive cross-sectional design. A convenience sampling technique was used. A target population of 152 respondents was included in the study. Research-based questionnaires were used to collect data from the respondents. Data were analyzed using SPSS software. Results: The prevalence of SAM in children aged 6-59 months attending MRRH is 34.2%. The following factors were significantly associated with SAM: birth order 1-3rd 61.5%, birth interval 5 71.2%, unsafe source of water 76.9%, breastfeeding < 8 times 69.2%, early or delayed weaning 78.8%, previous infection 67.3%, diarrhea for >1 week 46.3%. Conclusions: The findings of this study indicated that birth order, birth interval residence, education level, oc- cupation, family size, source of water, age of weaning, frequency of breastfeeding, previous infections, and diarrhea were major factors associated with SAM among children aged 6-59 months. Recommendations: Government through the Ministry of Health should resort to mass screening of children in the Karamoja region to combat the increasing prevalence of SAM in Karamoja. Health education on the importance of family planning should be passed on to them to correctly plan for good birth intervals and manageable family sizes. Emphasis on education for all should be put in place. Management of the underlying conditions, and health education on the importance of breastfeeding should be put in place to fight this epidemic.

Introduction Evidence-based and scalable prevention and promotion focused mental health and psychosocial support interventions are needed for conflict-affected populations in humanitarian settings. This study retrospectively assessed whether participation in Self Help Plus (SH+) versus enhanced usual care (EUC) resulted in reduced incidence of probable mental disorder and increased positive mental health and well-being post-intervention among South Sudanese refugee women in Uganda.Methods This study used secondary data from treatment-oriented pilot (n=50) and fully-powered cluster randomised controlled trials (cRCT)s (n=694) of SH+ versus EUC. Data from baseline and post-intervention assessments were combined. A composite latent indicator for mental health problems was generated using mental health and well-being measures included in both cRCTs. In order to assess incidence, a binary variable approximating probable mental disorder was created to exclude those with probable mental disorder from the analysis sample and as the primary prevention outcome. The promotive effects of SH+ relative to EUC were examined in the same sample by assessing subjective well-being and psychological flexibility scale scores.Results A single factor for mental health problems was identified with all factor loadings >0.30 and acceptable internal consistency (α=0.70). We excluded 161 women who met criteria for probable mental disorder at baseline. Among those with at least moderate psychological distress but without probable mental disorder at baseline and with follow-up data (n=538), the incidence of probable mental disorder at post-intervention was lower among those who participated in SH+ relative to EUC (Risk ratio =0.16, 95% CI: 0.05 to 0.53). Participation in SH+ versus EUC was also associated with increased subjective well-being (β=2.62, 95% CI: 1.63 to 3.60) and psychological flexibility (β=4.55, 95% CI: 2.92 to 6.18) at post-intervention assessment.Conclusions These results support the use and further testing of SH+ as a selective and indicated prevention and promotion focused psychosocial intervention in humanitarian settings.Trial registration number ISRCTN50148022.

ExoY virulence factors are members of a family of bacterial nucleotidyl cyclases (NCs) that are activated by specific eukaryotic cofactors and overproduce cyclic purine and pyrimidine nucleotides in host cells. ExoYs act as actin-activated NC toxins. Here, we explore the Vibrio nigripulchritudo Multifunctional-Autoprocessing Repeats-in-ToXin (MARTX) ExoY effector domain (Vn-ExoY) as a model for ExoY-type members that interact with monomeric (G-actin) instead of filamentous (F-actin) actin. Vn-ExoY exhibits moderate binding affinity to free or profilin-bound G-actin but can capture the G-actin:profilin complex, preventing its spontaneous or VASP- or formin-mediated assembly at F-actin barbed ends in vitro. This mechanism may prolong the activated cofactor-bound state of Vn-ExoY at sites of active actin cytoskeleton remodelling. We present a series of high-resolution crystal structures of nucleotide-free, 3'-deoxy-ATP- or 3'-deoxy-CTP-bound Vn-ExoY, activated by free or profilin-bound G-actin-ATP/-ADP, revealing that the cofactor only partially stabilises the nucleotide-binding pocket (NBP) of NC toxins. Substrate binding induces a large, previously-unidentified, closure of their NBP, confining catalytically important residues and metal cofactors around the substrate, and facilitating the recruitment of two metal ions to tightly coordinate the triphosphate moiety of purine or pyrimidine nucleotide substrates. We validate critical residues for both the purinyl and pyrimidinyl cyclase activity of NC toxins in Vn-ExoY and its distantly-related ExoY from Pseudomonas aeruginosa, which specifically interacts with F-actin. The data conclusively demonstrate that NC toxins employ a similar two-metal-ion mechanism for catalysing the cyclisation of nucleotides of different sizes. These structural insights into the dynamics of the actin-binding interface of actin-activated ExoYs and the multi-step activation of all NC toxins offer new perspectives for the specific inhibition of class II bacterial NC enzymes.