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Background and Aims: Premature deaths from cancer affect deprived communities disproportionately. The Department of Health has funded a programme in 19 Spearhead PCTs, delivered by the Improvement Foundation, to promote the early presentation and diagnosis of breast, bowel and lung cancers, with the ultimate intention of improving outcomes.Methods: The programme uses improvement methodology and is a unique approach involving local people working in partnership in their communities to raise awareness of cancer symptoms and promote early presentation. The teams work with primary care, other statutory organisations and with the voluntary sector. The specific contribution of the local people has been in the identification of hard-to-reach groups and the tailoring of effective health messages.Results: Interim results show an increase in the number of urgent 2-week referrals and the proportion of new cancer cases diagnosed through the urgent 2-week referral route (from 43% to 51%) for all three cancers. These results were statistically significant for the bowel cancer and lung cancer pathways. There was also an increase in the proportion with no spread at the time of diagnosis for bowel cancer (38-43%) and breast cancer (41-44.5%), but these results did not reach statistical significance.Discussion: This programme, helping community volunteers to lead work on raising awareness and promotion of earlier presentation of cancer symptoms in partnership with primary care and other professionals, is delivering positive early results. [ABSTRACT FROM AUTHOR]

The phase diagram of water at negative pressures as obtained from computer simulations for two models of water, TIP4P/2005 and TIP5P is presented. Several solid structures with lower densities than ice Ih, so-called virtual ices, were considered as possible candidates to occupy the negative pressure region of the phase diagram of water. In particular the empty hydrate structures sI, sII, and sH and another, recently proposed, low-density ice structure. The relative stabilities of these structures at 0 K was determined using empirical water potentials and density functional theory calculations. By performing free energy calculations and Gibbs–Duhem integration the phase diagram of TIP4P/2005 was determined at negative pressures. The empty hydrates sII and sH appear to be the stable solid phases of water at negative pressures. The phase boundary between ice Ih and sII clathrate occurs at moderate negative pressures, while at large negative pressures sH becomes the most stable phase. This behavior is in reasonable agreement with what is observed in density functional theory calculations. [ABSTRACT FROM AUTHOR]

Ab initio molecular dynamics (AIMD) based on density functional theory has been used to study small aluminium–oxygen complexes in water. Such Al–O clusters have been seen in several recent mass spectrometry studies. In this study, we have focused on trimeric Al–O clusters. The initial very compact trimeric Al–O structures opened up and formed linear Al–O chains. The typical Al–O coordination number in these chain structures was 5. We have performed long (up to 200 ps) AIMD simulations and these chain structures are stable on the nanosecond time scale. We have also studied the reactivity of the Al–O dimer and solvated Al. We found a formation path for the trimeric cluster, which has a action barrier (0.04 eV) and a reaction free energy of − 0.55 eV. This suggests that the association of a dimer and a monomer Al–O species is fast and thermodynamically a very favourable process. [ABSTRACT FROM AUTHOR]

Resolving the atomic structure of the surface of ice particles within clouds, over the temperature range encountered in the atmosphere and relevant to understanding heterogeneous catalysis on ice, remains an experimental challenge. By using first-principles calculations, we show that the surface of crystalline ice exhibits a remarkable variance in vacancy formation energies, akin to an amorphous material. We find vacancy formation energies as low as ~0.1-0.2?eV, which leads to a higher than expected vacancy concentration. Because a vacancy's reactivity correlates with its formation energy, ice particles may be more reactive than previously thought. We also show that vacancies significantly reduce the formation energy of neighbouring vacancies, thus facilitating pitting and contributing to pre-melting and quasi-liquid layer formation. These surface properties arise from proton disorder and the relaxation of geometric constraints, which suggests that other frustrated materials may possess unusual surface characteristics. [ABSTRACT FROM AUTHOR]

One of the main limitations in supporting experimental characterization of Al siting/pairing via modelling is the high computational cost of ab initio calculations. For this reason, most works rely on static or very short dynamical simulations, considering limited Al pairing/siting combinations. As a result, comparison with experiment suffers from a large degree of uncertainty. To alleviate this limitation we have developed neural network potentials (NNPs) which can dynamically sample across broad configurational and chemical spaces of sodium-form aluminosilicate zeolites, preserving the level of accuracy of the ab initio (dispersion-corrected metaGGA) training set. By exploring a wide range of Al/Na arrangements and a combination of experimentally relevant Si/Al ratios, we found that the 23 Na NMR spectra of dehydrated high-silica CHA zeolite offer an opportunity to assess the distribution and pairing of Al atoms. We observed that the 23 Na chemical shift is sensitive not only to the location of sodium in 6- and 8MRs, but also to the Al-Si n -Al sequence length. Furthermore, neglect of thermal and dynamical contributions was found to lead to errors of several ppm, and has a profound influence on the shape of the spectra and the dipolar coupling constants, thus necessitating the long-term dynamical simulations made feasible by NNPs. Finally, we obtained a predictive regression model for the 23 Na chemical shift in CHA (Si/Al = 35, 17, 11) that circumvents the need for expensive NMR density functional calculations and can be easily extended to other zeolite frameworks. By combining NNPs and regression methods, we can expedite the simulations of NMR properties and capture the effect of dynamics on the spectra, which is often overlooked in computational studies despite its clear manifestation in experimental setups.

By virtue of their open network structures and low densities, metal-organic frameworks (MOFs) are soft materials that exhibit elastic instabilities at low applied stresses. The conventional strategy for improving elastic stability is to increase the connectivity of the underlying MOF network, which necessarily increases the material density and reduces the porosity. Here we demonstrate an alternative paradigm, whereby elastic stability is enhanced in a MOF with an aperiodic network topology. We use a combination of variable-pressure single-crystal X-ray diffraction measurements and coarse-grained lattice-dynamical calculations to interrogate the high-pressure behaviour of the topologically aperiodic system TRUMOF-1, which we compare against that of its ordered congener MOF-5. We show that the topology of the former quenches the elastic instability responsible for pressure-induced framework collapse in the latter, much as irregularity in the shapes and sizes of stones acts to prevent cooperative mechanical failure in drystone walls. Our results establish aperiodicity as a counter-intuitive design motif in engineering the mechanical properties of framework structures that is relevant to MOFs and larger-scale architectures alike., (© 2024. The Author(s).)

Low-intensity Transcranial Ultrasound Stimulation (TUS) is a promising non-invasive technique for deep-brain stimulation and focal neuromodulation. Research with animal models and computational modelling has raised the possibility that TUS can be biased towards enhancing or suppressing neural function. Here, we first conduct a systematic review of human TUS studies for perturbing neural function and alleviating brain disorders. We then collate a set of hypotheses on the directionality of TUS effects and conduct an initial meta-analysis on the human TUS study reported outcomes to date ( n = 32 studies, 37 experiments). We find that parameters such as the duty cycle show some predictability regarding whether the targeted area's function is likely to be enhanced or suppressed. Given that human TUS sample sizes are exponentially increasing, we recognize that results can stabilize or change as further studies are reported. Therefore, we conclude by establishing an Iowa-Newcastle (inTUS) resource for the systematic reporting of TUS parameters and outcomes to support further hypothesis testing for greater precision in brain stimulation and neuromodulation with TUS.

This study aims to report on the development and validation of digital educational materials based on the dimensions of home cooking skills (HCS) assessed on a scale destined for PHC professionals, following the recommendations of The Dietary Guidelines for the Brazilian Population and on The Food and Nutrition Education Framework (FNE) for Public Policies. Five videos and graphic materials were developed with proposals for activities to develop HCS and encourage its implementation in actions and guidelines in the community and in professional care. The content of the materials was evaluated by experts using the Two-Round Delphi-based technique and statistical analyses for evidence of consensus. Specialists presented comments to improve the products and their applicability. The materials presented decoded language and playful illustrations with characters representative of the target population. Evidence of satisfactory content validity was presented and can be used in permanent education actions, seeking the qualification of the workforce and in FNE actions within the scope of the law. The graphic materials make it possible to associate the content of the videos with practice in contexts consistent with the reality of the individuals.

Tribo- and contact electrification remain poorly understood, baffling and discombobulating scientists for millennia. Despite the technology needed to harvest mechanical energy with triboelectric generators being incredibly rudimentary and the fact that a triboelectric output can be obtained from almost any two material combinations, research into triboelectric generator materials typically focuses on achieving the highest possible output; meanwhile, understanding trends and triboelectric behaviours of related but lower performing materials is often overlooked or not studied. Metal-organic frameworks, a class of typically highly porous and crystalline coordination polymers are excellent media to study to fill this knowledge gap. Their chemistry, topology and morphology can be individually varied while keeping other material properties constant. Here we study 5 closely related zeolitic-imidazolate type metal-organic frameworks for their triboelectric performance and behaviour by contact-separating each one with five counter materials. We elucidate the triboelectric electron transfer behaviour of each material, develop a triboelectric series and characterise the surface potential by Kelvin-probe force microscopy. From our results we draw conclusions on how the chemistry, morphology and topology affect the triboelectric output by testing and characterising our series of frameworks to help better understand triboelectric phenomena., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Introduction: School feeding programs are important for ensuring food security and promoting child health and development, particularly in low-income countries. In view of this importance, it is possible to increase the quality of these meals by diversifying the vegetables offered and incorporating underutilized plants to improve dietary diversity and nutritional quality into school meals., Methods: This study was carried out using the action research methodology following the implementation and development of the "Inova na Horta" project in the city of Jundiaí, São Paulo, Brazil. The project was based on the existing and functioning physical and organizational structure of a municipal organic farm. Vegetables were selected from among 210 non-conventional species and varieties, which were further selected for continuous production based on 8 nutritional, culinary and cultivation criteria., Results: Thirty-four vegetables were selected for continuous cultivation and provisions to the school kitchens. Nine tons of vegetables were produced and provided to 90 municipal schools from 2020-2023. Leafy vegetables accounted for most the production, with a total weight of 6441 kg corresponding to 71.6% of the total harvest. Kitchen teams were trained throughout the project duration., Discussion: The feasibility of the production and culinary use of 34 biodiverse, nutrient-rich and underutilized food vegetables for school meals was demonstrated. The selected vegetables are nutrient-rich and contain higher amounts of minerals and proteins than the control vegetables (conventional vegetables), thus complementing several nutrients in school meals. This methodology can be replicated by municipalities of various sizes as a public policy of food and nutritional security associated with the valorization of local biodiversity., Competing Interests: NM was employed by Brazilian Agricultural Research Corporation (EMBRAPA), EMBRAPA Hortaliças. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ranieri, Madeira, Slater, de Toledo Marchesi, Delgado de Oliveira, Badue and Mauad.)

Background: Patients with choledocholithiasis are often treated with endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). Upfront LC, intraoperative cholangiogram (IOC), and possible transcystic laparoscopic common bile duct exploration (LCBDE) could potentially avoid the need for ERCP. We hypothesized that upfront LC + IOC ± LCBDE will decrease length of stay (LOS) and the total number of interventions for children with suspected choledocholithiasis., Methods: A multicenter, retrospective cohort study was performed on pediatric patients (<18 years) between 2018 and 2022 with suspected choledocholithiasis. Demographic and clinical data were compared for upfront LC + IOC ± LCBDE and possible postoperative ERCP (OR1st) versus preoperative ERCP prior to LC (OR2nd). Complications were defined as postoperative pancreatitis, recurrent choledocholithiasis, bleeding, or abscess., Results: Across four centers, 252 children with suspected choledocholithiasis were treated with OR1st (n = 156) or OR2nd (n = 96). There were no differences in age, gender, or body mass index. Of the LCBDE patients (72/156), 86% had definitive intraoperative management with the remaining 14% requiring postoperative ERCP. Complications were fewer and LOS was shorter with OR1st (3/156 vs. 15/96; 2.39 vs 3.84 days, p < 0.05)., Conclusion: Upfront LC + IOC ± LCBDE for children with choledocholithiasis is associated with fewer ERCPs, lower LOS, and decreased complications. Postoperative ERCP remains an essential adjunct for patients who fail LCBDE. Further educational efforts are needed to increase the skill level for IOC and LCBDE in pediatric patients with suspected choledocholithiasis., Level of Evidence: Level III., (Copyright © 2023 Elsevier Inc. All rights reserved.)

We explore the role and nature of torsional flexibility of carboxylate-benzene links in the structural chemistry of metal-organic frameworks (MOFs) based on Zn and benzenedicarboxlyate (bdc) linkers. A particular motivation is to understand the extent to which such flexibility is important in stabilising the unusual topologically aperiodic phase known as TRUMOF-1. We compare the torsion angle distributions of TRUMOF-1 models with those for crystalline Zn/1,3-bdc MOFs, including a number of new materials whose structures we report here. We find that both periodic and aperiodic Zn/1,3-bdc MOFs sample a similar range of torsion angles, and hence the formation of TRUMOF-1 does not require any additional flexibility beyond that already evident in chemically-related crystalline phases. Comparison with Zn/1,4-bdc MOFs does show, however, that the lower symmetry of the 1,3-bdc linker allows access to a broader range of torsion angles, reflecting a greater flexibility of this linker., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Background: The optimal diagnosis and treatment of appendicitis remains controversial. This systematic review details the evidence and current best practices for the evaluation and management of uncomplicated and complicated appendicitis in adults and children., Methods: Eight questions regarding the diagnosis and management of appendicitis were formulated. PubMed, Embase, CINAHL, Cochrane and clinicaltrials.gov/NLM were queried for articles published from 2010 to 2022 with key words related to at least one question. Randomized and non-randomized studies were included. Two reviewers screened each publication for eligibility and then extracted data from eligible studies. Random effects meta-analyses were performed on all quantitative data. The quality of randomized and non-randomized studies was assessed using the Cochrane Risk of Bias 2.0 or Newcastle Ottawa Scale, respectively., Results: 2792 studies were screened and 261 were included. Most had a high risk of bias. Computerized tomography scan yielded the highest sensitivity (> 80%) and specificity (> 93%) in the adult population, although high variability existed. In adults with uncomplicated appendicitis, non-operative management resulted in higher odds of readmission (OR 6.10) and need for operation (OR 20.09), but less time to return to work/school (SMD - 1.78). In pediatric patients with uncomplicated appendicitis, non-operative management also resulted in higher odds of need for operation (OR 38.31). In adult patients with complicated appendicitis, there were higher odds of need for operation following antibiotic treatment only (OR 29.00), while pediatric patients had higher odds of abscess formation (OR 2.23). In pediatric patients undergoing appendectomy for complicated appendicitis, higher risk of reoperation at any time point was observed in patients who had drains placed at the time of operation (RR 2.04)., Conclusions: This review demonstrates the diagnosis and treatment of appendicitis remains nuanced. A personalized approach and appropriate patient selection remain key to treatment success. Further research on controversies in treatment would be useful for optimal management., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Actomyosin contractility originating from interactions between F-actin and myosin motors in the actin cytoskeleton generates mechanical forces and drives a wide range of cellular processes including cell migration and cytokinesis. To probe the interactions between F-actin and myosin motors, the myosin motility assay has been popularly employed, which consists of myosin heads attached to a glass surface and F-actins gliding on the surface via interactions with the heads. Several experiments have shown that F-actins move in a collective fashion due to volume-exclusion effects between neighboring F-actins. Furthermore, Computational models have shown how changes in key parameters lead to diverse pattern formation in motility assay. However, in most of the computational models, myosin motors were implicitly considered by applying a constant propulsion force to filaments to reduce computational cost. This simplification limits the physiological relevance of the insights provided by the models and potentially leads to artifacts. In this study, we employed an agent-based computational model for the motility assay with explicit immobile motors interacting with filaments. We rigorously account for the kinetics of myosin motors including the force-velocity relationship for walking and the binding and unbinding behaviors. We probed the effects of the length, rigidity, and concentration of filaments and repulsive strength on collective movements and pattern formation. It was found that four distinct types of structures-homogeneous networks, flocks, bands, and rings-emerged as a result of collisions between gliding filaments. We further analyzed the frequency and morphology of these structures and the curvature, alignment, and rotational motions of filaments. Our study provides better insights into the origin and properties of patterns formed by gliding filaments beyond what was shown before., (© 2023 The Authors. Cytoskeleton published by Wiley Periodicals LLC.)

Purpose: There are no manually propelled wheelchairs on the market that are mobile in both seated and standing positions. In response to this product gap, our group formerly designed a mobile manual standing wheelchair (MMSW) and gathered stakeholder feedback. The purpose of this study was to refine the MMSW based on feedback, including weight and width reduction, and evaluate its performance., Materials and Methods: The MMSW was subjected to ANSI/RESNA stability testing, and three male participants completed a subset of the wheelchair skills test, including a 100-m roll test in the MMSW (seated and standing) and in their ultralight wheelchair., Results: The MMSW met ANSI/RESNA stability safety standards. During the 100-m roll test, participants reached speeds with the MMSW in both the standing and sitting postures similar or greater than those typical of moving in the home environment (1.11 m/s seated; 0.79 m/s standing). Mobility speeds in the MMSW in the standing position were about three times faster than average walking speeds in exoskeletons (0.26 m/s exoskeletons). With the addition of chain drive bracing to the MMSW, one user was able to reach speeds in the standing position similar to average neurotypical walking speeds indicating the possibility for wheelchair users to be able to move in pace with family and friends., Conclusion: All participants expressed interest in the MMSW to facilitate improved quality of life. Further work is needed to test the utility of the MMSW in home and community settings, and its potential effects on standing time and health outcomes.Implications for rehabilitationManual standing wheelchairs with standing mobility may increase functional utility and length of standing time for manual wheelchair usersIncreased standing time may lead to several health benefits for manual wheelchair users.

Objective: To assess the clinical implications of cryoanalgesia for pain management in children undergoing minimally invasive repair of pectus excavatum (MIRPE)., Background: MIRPE entails significant pain management challenges, often requiring high postoperative opioid use. Cryoanalgesia, which blocks pain signals by temporarily ablating intercostal nerves, has been recently utilized as an analgesic adjunct. We hypothesized that the use of cryoanalgesia during MIRPE would decrease postoperative opioid use and length of stay (LOS)., Materials and Methods: A multicenter retrospective cohort study of 20 US children's hospitals was conducted of children (age below 18 years) undergoing MIRPE from January 1, 2014, to August 1, 2019. Differences in total postoperative, inpatient, oral morphine equivalents per kilogram, and 30-day LOS between patients who received cryoanalgesia versus those who did not were assessed using bivariate and multivariable analysis. P value <0.05 is considered significant., Results: Of 898 patients, 136 (15%) received cryoanalgesia. Groups were similar by age, sex, body mass index, comorbidities, and Haller index. Receipt of cryoanalgesia was associated with lower oral morphine equivalents per kilogram (risk ratio=0.43, 95% confidence interval: 0.33-0.57) and a shorter LOS (risk ratio=0.66, 95% confidence interval: 0.50-0.87). Complications were similar between groups (29.8% vs 22.1, P =0.07), including a similar rate of emergency department visit, readmission, and/or reoperation., Conclusions: Use of cryoanalgesia during MIRPE appears to be effective in lowering postoperative opioid requirements and LOS without increasing complication rates. With the exception of preoperative gabapentin, other adjuncts appear to increase and/or be ineffective at reducing opioid utilization. Cryoanalgesia should be considered for patients undergoing this surgery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Diet quality is associated with psychobiological, psychological, biological, and physiological factors of individuals, and in the context of prolonged stress, such as the COVID-19 pandemic, it can lead to a worsening of the quality of food for undergraduates. This study aimed to analyze diet quality and associated factors in Brazilian undergraduates., Methods: Data were collected from 4,799 undergraduate students from all Brazilian regions, from August 2020 to February 2021. The online questionnaire contained socioeconomic variables, the ESQUADA scale to assess diet quality, self-referred changes in weight, the Brazilian food insecurity scale (EBIA), sleep assessment and the perceived stress scale. Unconditional multiple logistic regression analysis was performed to study variables associated with poor and very poor diet quality., Results: Most of participants presented a good diet quality (51.7%), while 9.8% had a poor or very poor diet quality and only 1.1% had an excellent diet quality. 58.2% of undergraduates reported to have an increase in weight during the pandemic and 74.3% of the students presented elevated stress during the pandemic. Logistic regressions showed students who gained weight during the pandemic presented the highest AOR = 1.56 (95% CI = 1.12-2.20) for poor or very poor diet quality. The elevated perceived stress was also associated with a higher AOR = 2.85 (95% CI = 1.71-4.74) for poor or very poor diet quality., Conclusion: Most of the studied undergraduates presented a good diet quality. Nevertheless, poor/very poor diet quality was associated with higher perceived stress and weight gain. Our study indicated that policies should beaimed at the socioeconomically most vulnerable undergraduates, those in a situation of food and nutritional insecurity, high perceived stress, and who gained weight during the pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Galvão, Santos, Slater, Lyra, Rolim, Ramalho, Dalamaria, Martins,Höfelmann, Crispim, Gorgulho, Rodrigues, Marchioni and Maciel.)

When tiles decorated to lower their symmetry are joined together, they can form aperiodic and labyrinthine patterns. Such Truchet tilings offer an efficient mechanism of visual data storage related to that used in barcodes and QR codes. We show that the crystalline metal-organic framework [OZn 4 ][1,3-benzenedicarboxylate] 3 (TRUMOF-1) is an atomic-scale realization of a complex three-dimensional Truchet tiling. Its crystal structure consists of a periodically arranged assembly of identical zinc-containing clusters connected uniformly in a well-defined but disordered fashion to give a topologically aperiodic microporous network. We suggest that this unusual structure emerges as a consequence of geometric frustration in the chemical building units from which it is assembled.

The production of widely used polymers such as polyester currently relies upon the chemical separation of and transformation of xylene isomers. The least valuable but most prevalent isomer is meta -xylene which can be selectively transformed into the more useful and expensive para -xylene isomer using a zeolite catalyst but at a high energy cost. In this work, high-throughput screening of existing and hypothetical zeolite databases containing more than two million structures was performed, using a combination of classical simulation and deep neural network methods to identify promising materials for selective adsorption of meta -xylene. Novel anomaly detection techniques were applied to the heavily biased classification task of identifying structures with a selectivity greater than that of the best performing existing zeolite, ZSM-5 (MFI topology). Eight hypothetical zeolite topologies are found to be several orders of magnitude more selective towards meta -xylene than ZSM-5 which may provide an impetus for synthetic efforts to realise these promising materials. Moreover, the leading hypothetical frameworks identified from the screening procedure require a markedly lower operating temperature to achieve the diffusion seen in existing materials, suggesting significant energetic savings if the frameworks can be realised., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Objective: To develop and validate an instrument for measuring the home cooking skills of health professionals involved with guidelines for promoting adequate and healthy food in primary health care., Methods: This is a methodological study with a psychometric approach, carried out in the city of São Paulo between January and November 2020, to develop and validate a self-applied online instrument. The data of the 472 participants were presented by descriptive statistics. Content validation was performed by expert judgment using the two round Delphi technique and empirical statistics for consensus evidence. Exploratory factor analysis was used for construct validation and reliability analysis, and the model adjustment rates and composite reliability were analyzed., Results: The instrument presented satisfactory content validity for CVRc indices and 𝜅 in the two rounds of the Delphi technique. After the factor analysis, the final model of the Primary Health Care Home Cooking Skills Scale presented 29 items with adequate factorial loads (> 0.3). Bartlett's and Kaiser-Meyer-Olkin's (KMO) tests of sphericity performed in exploratory factorial analysis suggested interpretability in the correlation matrix, the parallel analysis indicated four domains and explained variance of 64.1%. The composite reliability of the factors was adequate (> 0.70) and the H-index suggested replicable factors in future studies. All adjustment rates proved to be adequate., Conclusions: The Primary Health Care Home Cooking Skills Scale presented evidence of validity and reliability. It is short and easy to apply and will make it possible to reliably ascertain the need for qualification of the workforce, favoring the planning of actions and public policies of promotion of adequate and healthy food in primary health care.

Undergraduates may face challenges to assure food security, related to economic and mental distress, especially during the COVID-19 pandemic. This study aimed to assess food insecurity and its associated factors in undergraduates during the COVID-19 pandemic. An online cross-sectional study was conducted from August 2020 to February 2021 with 4775 undergraduates from all Brazilian regions. The questionnaire contained socio-economic variables, the validated Brazilian food insecurity scale, and the ESQUADA scale to assess diet quality. The median age of the students was 22.0 years, and 48.0% reported income decreasing with the pandemic. Food insecurity was present in 38.6% of the students, 4.5% with severe food insecurity and 7.7% moderate. Logistic regressions showed students with brown and black skin color/race presented the highest OR for food insecurity; both income and weight increase or reduction during the pandemic was also associated with a higher OR for food insecurity, and better diet quality was associated with decreased OR for food insecurity. Our study showed a considerable presence of food insecurity in undergraduates. Policy for this population must be directed to the most vulnerable: those with brown and black skin color/race, who changed income during the pandemic, and those presented with difficulties maintaining weight and with poor diet quality.

The evaluation of the National School Food Program (PNAE) is a strategic action to ensure the quality of management. This study aims to develop and validate an instrument of performance indicators to assess the management of the PNAE in the national context. A psychometric study was carried out for the development and validation of performance indicators. Twelve indicators were subsequently established and evaluated by an expert panel concerning seven attributes. The Delphi technique was used for the consensus of the expert panel, and the content validity of the indicators was analyzed with the Content Validity Ratio. Nutritionists working on the implementation of the PNAE assessed the relevance of the indicators by answering an online questionnaire to construct validity and reliability. Thirteen (43.3%, 13/30) experts participated in the Delphi round 1 and nine (69.2%, 9/13) completed the Delphi round 2. A new indicator was developed after the experts' suggestions. Furthermore, 281 nutritionists participated in this study assessing the relevance of the indicators. Overall, content and construct validity were achieved for 13 indicators. All were considered relevant and had the potential to promote the assessment of PNAE operational management.

Ion exchange membranes (IEMs) are widely used in water treatment applications such as electrodialysis. However, the exploration of IEMs as effective antibacterial food contact materials (e.g., food packaging membranes) against pathogenic bacteria to ensure food safety has not been reported. Here, we report a simple but effective method to prepare high performance antibacterial membranes via ion exchange coupled with in-situ reduction. The general membrane properties are characterized using SEM, EDS, FTIR, XPS, XRD, DSC, TGA, water uptake, etc. The distribution of silver and copper in the membranes are generally in line with the distribution of sulfur, indicating that the antibacterial ions are introduced into the membranes via ion exchange and are bonded with the sulfonate groups in the membranes. The antibacterial performance is investigated using zone of inhibition tests and continuous bacteria growth inhibition tests. All of the prepared membranes show obvious antibacterial activities compared to the bare cation exchange membranes. The diameters of inhibition zone against Staphylococcus aureus (S. aureus) are all larger than those of Escherichia coli (E. coli), indicating that the prepared membranes are more efficient in inhibiting S. aureus compared to E. coli. Furthermore, the silver-based membrane shows more sustainable antibacterial activities compared to the copper-based membrane. Especially, the results clearly reveal that the silver-based membrane is capable of killing bacteria instead of just inhibiting the growth of bacteria. We have shown for the first time that membranes derived from IEMs have the potential as food contact materials to inhibit the growth of pathogenic bacteria so as to eliminate the risk of bacterial infections and meanwhile delay food spoilage due to bacteria growth., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring., Methods: ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the "non-response" rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5., Conclusion: Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

During various physiological processes, such as wound healing and cell migration, cells continuously interact mechanically with a surrounding extracellular matrix (ECM). Contractile forces generated by the actin cytoskeleton are transmitted to a surrounding ECM, resulting in structural remodeling of the ECM. To better understand how matrix remodeling takes place, a myriad of in vitro experiments and simulations have been performed during recent decades. However, physiological ECMs are viscoelastic, exhibiting stress relaxation or creep over time. The time-dependent nature of matrix remodeling induced by cells remains poorly understood. Here, we employed a discrete model to investigate how the viscoelastic nature of ECMs affects matrix remodeling and stress profiles. In particular, we used explicit transient cross-linkers with varied density and unbinding kinetics to capture viscoelasticity unlike most of the previous models. Using this model, we quantified the time evolution of generation, propagation, and relaxation of stresses induced by a contracting cell in an ECM. It was found that matrix connectivity, regulated by fiber concentration and cross-linking density, significantly affects the magnitude and propagation of stress and subsequent matrix remodeling, as characterized by fiber displacements and local net deformation. In addition, we demonstrated how the base rate and force sensitivity of cross-linker unbinding regulate stress profiles and matrix remodeling. We verified simulation results using in vitro experiments performed with fibroblasts encapsulated in a three-dimensional collagen matrix. Our study provides key insights into the dynamics of physiologically relevant mechanical interactions between cells and a viscoelastic ECM.

Background: The Patient Safety Huddle (PSH) is a brief multidisciplinary daily meeting held to discuss threats to patient safety and actions to mitigate risk. Despite growing interest and application of huddles as a mechanism for improving safety, evidence of their impact remains limited. There is also variation in how huddles are conceived and implemented with insufficient focus on their fidelity (the extent to which delivered as planned) and potential ways in which they might influence outcomes. The Huddle Up for Safer Healthcare (HUSH) project attempted to scale up the implementation of patient safety huddles (PSHs) in five hospitals - 92 wards - across three UK NHS Trusts. This paper aims to assess their fidelity, time to embed, and impact on teamwork and safety culture., Methods: A multi-method Developmental Evaluation was conducted. The Stages of Implementation Checklist (SIC) was used to determine time taken to embed PSHs. Observations were used to check embedded status and fidelity of PSH. A Teamwork and Safety Climate survey (TSC) was administered at two time-points: pre- and post-embedding. Changes in TSC scores were calculated for Trusts, job role and clinical speciality., Results: Observations confirmed PSHs were embedded in 64 wards. Mean fidelity score was 4.9/9. PSHs frequently demonstrated a 'fear free' space while Statistical Process Control charts and historical harms were routinely omitted. Analysis showed a positive change for the majority (26/27) of TSC questions and the overall safety grade of the ward., Conclusions: PSHs are feasible and effective for improving teamwork and safety culture, especially for nurses. PSH fidelity criteria may need adjusting to include factors deemed most useful by frontline staff. Future work should examine inter-disciplinary and role-based differences in TSC outcomes., (© 2021. The Author(s).)

The thermal conductivity of crystalline materials cannot be arbitrarily low, as the intrinsic limit depends on the phonon dispersion. We used complementary strategies to suppress the contribution of the longitudinal and transverse phonons to heat transport in layered materials that contain different types of intrinsic chemical interfaces. BiOCl and Bi 2 O 2 Se encapsulate these design principles for longitudinal and transverse modes, respectively, and the bulk superlattice material Bi 4 O 4 SeCl 2 combines these effects by ordering both interface types within its unit cell to reach an extremely low thermal conductivity of 0.1 watts per kelvin per meter at room temperature along its stacking direction. This value comes within a factor of four of the thermal conductivity of air. We demonstrated that chemical control of the spatial arrangement of distinct interfaces can synergically modify vibrational modes to minimize thermal conductivity., (Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Objective: Assess two validity evidences of the diet quality scale (ESQUADA) for the selection of items with better discrimination of the Brazilians' diet quality and propose a description in score levels., Methods: Brazilian adolescents and adults residing in the country (n = 2,059) answered an online questionnaire with 52 items, shared on social networks and email lists between March and April 2018. Statistical tests were applied to analyze the validity and reliability of the instrument's evidence. Factor analysis was applied to study the dimensionality of the questionnaire items. Item response theory was applied to identify the discrimination and location of items on the continuum, construct the scale and assess the differential item functioning in terms of sex and age., Results: Among the 52 items of the questionnaire, 25 had greater measurement accuracy, with adequate adjustment and reliability. The item on the habit of eating ultra-processed foods at home showed the best discrimination of diet quality. No item showed differential functioning regarding sex and age. In the construction of the ESQUADA, five diet quality levels were identified: very poor, poor, good, very good and excellent. It was observed that while breakfast cereals and/or cereal bars are more frequently consumed by individuals with "very poor" diet quality; nuts and/or walnuts are most often consumed by those individuals with "excellent" diet quality., Conclusion: The ESQUADA consists of 25 precise items with no differential functioning to assess the quality of Brazilians' diet. The construction of the ESQUADA made it possible to recognize food consumption and dietary practices characteristic of each level of diet quality.

Background: Culinary skills are important objects of study in the field of Public Health. Studies that propose to develop instruments for assessing such construct show lack of methodological uniformity to report validity and reliability of their instruments., Objective: To identify studies that have developed instruments to measure culinary skills in adult population, and critically assess their psychometric properties., Design: We conducted a systematic review according to the PRISMA statement. We searched literature PubMed/Medline, Scopus, LILACS, and Web of Science databases until January 2021, and consulted Google Scholar for relevant grey literature. Two reviewers independently selected the studies, conducted data extraction, and assessed the psychometric quality of the instruments. A third reviewer resolved any doubts or disagreements in all steps of the systematic review., Results: The search identified 1148 potentially relevant studies, out of which 9 met the inclusion criteria. In addition, we included 3 studies by searching the related articles and the reference lists of these studies, totaling 12 included studies in this review. Ten studies reported the development of tools measuring culinary skills in adults and 2 studies performed cross-cultural adaptations of original instruments. We considered adequate quality of internal consistency reliability in four studies. One study received adequate rating for test-retest reliability. No studies presented adequate rating for content validity and four studies showed satisfactory results for at least one type of construct validity. One study reported criterion validity and the quality of this psychometric property was inadequate., Conclusions: We identified many studies that surveyed culinary skills. Although the isolated measures appraised in this review show good promise in terms of quality of psychometric properties, no studies presented adequate measures for each aspect of reliability and validity. A more consistent and consensual definition of culinary skills is recommended. The flaws observed in these studies show that there is a need for ongoing research in the area of the psychometric properties of instruments assessing culinary skills., Competing Interests: The authors have declared that no competing interests exist.

During photosynthesis, electrons are transferred between the cytochrome b6f complex and photosystem I. This is carried out by the protein plastocyanin in plant chloroplasts, or by either plastocyanin or cytochrome c6 in many cyanobacteria and eukaryotic algal species. There are three further cytochrome c6 homologs: cytochrome c6A in plants and green algae, and cytochromes c6B and c6C in cyanobacteria. The function of these proteins is unknown. Here, we present a comprehensive analysis of the evolutionary relationship between the members of the cytochrome c6 family in photosynthetic organisms. Our phylogenetic analyses show that cytochromes c6B and c6C are likely to be orthologs that arose from a duplication of cytochrome c6, but that there is no evidence for separate origins for cytochromes c6B and c6C. We therefore propose renaming cytochrome c6C as cytochrome c6B. We show that cytochrome c6A is likely to have arisen from cytochrome c6B rather than by an independent duplication of cytochrome c6, and present evidence for an independent origin of a protein with some of the features of cytochrome c6A in peridinin dinoflagellates. We conclude with a new comprehensive model of the evolution of the cytochrome c6 family which is an integral part of understanding the function of the enigmatic cytochrome c6 homologs., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.)

Bulk crystalline ices with ultralow densities have been demonstrated to be thermodynamically metastable at negative pressures. However, the direct formation of these bulk porous ices from liquid water at negative pressures is extremely challenging. Inspired by approaches toward porous media based on host-guest chemistry, such as metal-organic frameworks and covalent organic frameworks, we herein demonstrate via molecular dynamics simulations that a class of ultralow-density porous ices with upright channels can be formed spontaneously from liquid water at 300 K with the assistance of carbon nanotube arrays. We refer to these porous ice polymorphs as water oxygen-vertex frameworks (WOFs). Notably, our simulations revealed that the liquid-WOF phase transition is first-order and occurs at room temperature. All the WOFs exhibited the unique structural feature that they can be regarded as assemblies of nanoribbons of hexagonal bilayer ice (2D ice I) at their armchair or zigzag edges. Based on density functional theory calculations, a comprehensive phase diagram of the WOFs was constructed considering both the thermodynamic and thermal stabilities of the porous ices at negative pressures. Like other types of porous media, these WOFs may be applicable to gas storage, purification, and separation. Moreover, these biocompatible porous ice networks may be exploited as medical-related carriers., Competing Interests: The authors declare no competing interest.

This article aims to identify studies that developed quality indicator for the management of the National School Feeding Program (PNAE, in Brazilian context) and to critically appraise the properties of their instruments. Systematic review using Scopus, Lilacs, Pubmed and Web of Science for data collection. The search was limited to studies between 2009 and 2019. The search strategy included search terms related to school feeding, program evaluation, and indicator. The indicators were evaluated using the Appraisal of Indicators through Research and Evaluation instrument. The search identified 1,355 studies, of which 14 were potentially relevant records and 10 met the inclusion criteria. Most studies used a literature review with consensus techniques in the development of the instrument and a frame work format to evaluate the PNAE. None of them presented evidence of validity of the instrument. The highest level was achieved on the domain 'Purpose, relevance and organizational context', followed by 'Stakeholder involvement', 'Additional evidence, formulation and usage', and 'Scientific evidence'. This review found gaps in the methodology of studies that had developed quality indicators for the management of PNAE. Future development of these instruments should include validity evidence.

Purpose of Review: Major trauma remains one of the leading causes of death worldwide with traumatic brain injury and uncontrolled traumatic bleeding as the main determinants of fatal outcome. Interestingly, the therapeutic approach to trauma-associated bleeding and coagulopathy shows differences between geographic regions, that are reflected in different guidelines and protocols., Recent Findings: This article summarizes main principles in coagulation diagnostics and compares different strategies for treatment of massive hemorrhage after trauma in different regions of the world. How would a bleeding trauma patient be managed if they got hit by the bus in the United States, United Kingdom, Germany, Switzerland, Austria, Denmark, Australia, or in Japan?, Summary: There are multiple coexistent treatment standards for trauma-induced coagulopathy in different countries and different trauma centers. Most of them initially follow a protocol-based approach and subsequently focus on predefined clinical and laboratory targets., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Predictive modeling with remotely sensed data requires an accurate representation of spatial variability by ground truth data. In this study, we assessed the reliability of the size and location of ground truth data in capturing the landscape spatial variability embedded in the Airborne Visible Infrared Imaging Spectrometer-Next Generation (AVIRIS-NG) hyperspectral image in an agricultural region in Anand, India. We derived simulated spectral vegetation and soil indices using Gaussian simulation from AVIRIS-NG image for two point-location datasets, (1) ground truth points from adaptive sampling and (2) points from conditional Latin Hypercube Sampling (cLHS). We compared values of the simulated image indices against the actual image indices (measured) through the analysis of mean absolute errors. Modeling the variogram of the measured indices with the hyperspectral image in high spatial resolution (4m), is an effective way to characterize the spatial heterogeneity at the landscape level. We used geostatistical techniques to analyze the shapes of experimental variograms in order to assess whether or not the ground truth points, when compared against the cLHS-derived points, captured the spatial structures and variability of the studied agricultural area using measured indices. In addition, we explored the capability of the variogram by running tests in different point sample sizes. The ground truth and cLHS datasets were able to derive equivalent values for field spatial variability from image indices, according to our findings. Furthermore, this research presents a methodology for selecting spectral indices and determining the best sample size for efficiently replicating spatial patterns in hyperspectral images., Competing Interests: The authors declare no conflict of interest., (© 2021 Published by Elsevier Ltd.)

Patient-reported outcome measures (PROMs) are increasingly utilized as endpoints in clinical trials. The Short Form Health Survey-12 (SF-12v2) is a generic PROM for adults. We sought to evaluate the validity of SF-12v2 in adults with osteogenesis imperfecta (OI). Physical and mental health-related quality of life (HRQoL) were assessed in a large cohort of adults in a multicenter, observational, natural history study. Physical HRQoL scores were correlated with the Gillette Functional Assessment Questionnaire (GFAQ). We calculated sample sizes required in clinical trials with crossover and parallel-group designs to detect clinically meaningful changes in physical HRQoL. Three hundred and two adults with OI types I, III, and IV were enrolled. Physical HRQoL scores in the study population were lower than population norms. Physical HRQoL scores moderately correlated with GFAQ for OI types I and IV. We found no correlations between mental and physical HRQoL. From a clinical trial readiness perspective, we show that SF-12v2 reliably measures physical function in adults with OI and can be utilized in crossover trials to detect meaningful physical HRQoL changes with small sample sizes. This study shows that SF-12v2 can be used to measure changes in physical HRQoL in response to interventions in OI., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To analyze the association between diet quality assessed with the Diet Quality Scale (ESQUADA) and the nutritional status and metabolic risk in adults., Methods: The data included 1,147 adults aged 20 to 59, from the population-based study with complex sampling. Weight, height, tricipital (TSF) and subscapular (SSF) skinfolds, and waist (WC) and mid-arm (MAC) circumferences were measured. Body mass index (BMI) and mid-arm muscle circumference (MAMC) were calculated. Nutritional status and metabolic risk were classified considering BMI and WC values, respectively. Diet quality was assessed with ESQUADA. Data were collected at household using the Epicollect5 application. Diet quality (in scores) was analyzed as continuous data and later categorized. The confidence interval was used for comparison between groups, Fisher's exact test for an association study. Adjusted multiple linear regression models were also estimated. P < 0.05 was adopted for statistical significance., Results: Overweight prevailed in 60.33% of individuals, especially among women (60.73%). High or very high metabolic risk was more frequent among women with "very good or excellent" diet quality. Higher diet quality score was associated with a reduction in TSF (β = -0.07; 95%CI -0.13 - -0.01) and an increase in MAMC (β = 0.09; 95%CI 0.00 - 0,18) in men and the reduction in weight (β = -0.04; 95%CI -0.07 - -0.01), SSF (β = -0.07; 95%CI -0.13 - -0,00) and WC in women (β = -0.06; 95%CI -0.09 - -0.02)., Conclusion: A better diet quality is positively associated with lean mass in men, and negatively with fat mass in men and women.

Modern functional glasses have been prepared from a wide range of precursors, combining the benefits of their isotropic disordered structures with the innate functional behavior of their atomic or molecular building blocks. The enhanced ionic conductivity of glasses compared to their crystalline counterparts has attracted considerable interest for their use in solid-state batteries. In this study, we have prepared the mixed molecular glass Ga 2 I 3.17 and investigated the correlations between the local structure, thermal properties, and ionic conductivity. The novel glass displays a glass transition at 60 °C, and its molecular make-up consists of GaI 4 - tetrahedra, Ga 2 I 6 2- heteroethane ions, and Ga + cations. Neutron diffraction was employed to characterize the local structure and coordination geometries within the glass. Raman spectroscopy revealed a strongly localized nonmolecular mode in glassy Ga 2 I 3.17 , coinciding with the observation of two relaxation mechanisms below T g in the AC admittance spectra.

Background: Achalasia is a rare, chronic, and morbid condition with evolving treatment. Peroral endoscopic myotomy (POEM) has gained considerable popularity, but its comparative effectiveness is uncertain. We aim to evaluate the literature comparing POEM to Heller myotomy (HM) and pneumatic dilation (PD) for the treatment of achalasia., Methods: We conducted a systematic review of comparative studies between POEM and HM or PD. A priori outcomes pertained to efficacy, perioperative metrics, and safety. Internal validity of observational studies and randomized trials (RCTs) was judged using the Newcastle Ottawa Scale and the Cochrane Risk of Bias 2.0 tool, respectively., Results: From 1379 unique literature citations, we included 28 studies comparing POEM and HM (n = 21) or PD (n = 8), with only 1 RCT addressing each. Aside from two 4-year observational studies, POEM follow-up averaged ≤ 2 years. While POEM had similar efficacy to HM, POEM treated dysphagia better than PD both in an RCT (treatment "success" RR 1.71, 95% CI 1.34-2.17; 126 patients) and in observational studies (Eckardt score MD - 0.43, 95% CI - 0.71 to - 0.16; 5 studies; I 2 21%; 405 patients). POEM needed reintervention less than PD in an RCT (RR 0.19, 95% CI 0.08-0.47; 126 patients) and HM in an observational study (RR 0.33, 95% CI 0.16, 0.68; 98 patients). Though 6-12 months patient-reported reflux was worse than PD in 3 observational studies (RR 2.67, 95% CI 1.02-7.00; I 2 0%; 164 patients), post-intervention reflux was inconsistently measured and not statistically different in measures ≥ 1 year. POEM had similar safety outcomes to both HM and PD, including treatment-related serious adverse events., Conclusions: POEM has similar outcomes to HM and greater efficacy than PD. Reflux remains a critical outcome with unknown long-term clinical significance due to insufficient data and inconsistent reporting.