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Abstract We initiate the study of how the insertion of magnetically charged states in 4d self-dual gauge theories impacts the 2d chiral algebras supported on the celestial sphere at asymptotic null infinity, from the point of view of the 4d/2d twistorial correspondence introduced by Costello and the second author. By reducing the 6d twistorial theory to a 3d holomorphic-topological theory with suitable boundary conditions, we can motivate certain non-perturbative enhancements of the celestial chiral algebra corresponding to extensions by modules arising from 3d boundary monopole operators. We also identify the insertion of 4d (non-abelian) monopoles with families of spectral flow automorphisms of the celestial chiral algebra.

Abstract The selection pressures that drove dramatic encephalisation processes through the mammal lineage remain elusive, as does knowledge of brain structure reorganisation through this process. In particular, considerable structural brain changes are present across the primate lineage, culminating in the complex human brain that allows for unique behaviours such as language and sophisticated tool use. To understand this evolution, a diverse sample set of humans' closest relatives with varying socio‐ecologies is needed. However, current brain banks predominantly curate brains from primates that died in zoological gardens. We try to address this gap by establishing a field pipeline mitigating the challenges associated with brain extractions of wild primates in their natural habitat. The success of our approach is demonstrated by our ability to acquire a novel brain sample of deceased primates with highly variable socio‐ecological exposure and a particular focus on wild chimpanzees. Methods in acquiring brain tissue from wild settings are comprehensively explained, highlighting the feasibility of conducting brain extraction procedures under strict biosafety measures by trained veterinarians in field sites. Brains are assessed at a fine‐structural level via high‐resolution MRI and state‐of‐the‐art histology. Analyses confirm that excellent tissue quality of primate brains sourced in the field can be achieved with a comparable tissue quality of brains acquired from zoo‐living primates. Our field methods are noninvasive, here defined as not harming living animals, and may be applied to other mammal systems than primates. In sum, the field protocol and methodological pipeline validated here pose a major advance for assessing the influence of socio‐ecology on medium to large mammal brains, at both macro‐ and microstructural levels as well as aiding with the functional annotation of brain regions and neuronal pathways via specific behaviour assessments.

Abstract This work introduces automated wind turbine optimization techniques based on full aero‐servo‐elastic models and investigates the potential of trailing edge flaps to reduce the levelized cost of energy (LCOE) of wind turbines. The Wind Energy with Integrated Servo‐control (WEIS) framework is improved to conduct the presented research. Novel methods for the generic implementation and tuning of trailing edge flap devices and their controller are also introduced. Primary flap and controller parameters are optimized to demonstrate potential maximum blade tip deflection reductions of 21%. Concurrent design optimization (i.e., co‐design) of a novel segmented wind turbine blade with trailing edge flaps and its controller is then conducted to demonstrate blade cost savings of 5%. Additionally, rotor diameter co‐design optimization is demonstrated to reduce the LCOE by 1.3% without significant load increases to the tower. These results demonstrate the efficacy of control co‐design optimization using trailing edge flaps, and the entirety of this work provides a foundation for numerous control co‐design‐oriented studies for distributed aerodynamic control devices.

Abstract Background Primary care and other health services have been disrupted during the COVID-19 pandemic, yet the consequences of these service disruptions on patients’ care experiences remain largely unstudied. People with mental-physical multimorbidity are vulnerable to the effects of the pandemic, and to sudden service disruptions. It is thus essential to better understand how their care experiences have been impacted by the current pandemic. This study aims to improve understanding of the care experiences of people with mental-physical multimorbidity during the pandemic and identify strategies to enhance these experiences. Methods We will conduct a mixed-methods study with multi-phase approach involving four distinct phases. Phase 1 will be a qualitative descriptive study in which we interview individuals with mental-physical multimorbidity and health professionals in order to explore the impacts of the pandemic on care experiences, as well as their perspectives on how care can be improved. The results of this phase will inform the design of study phases 2 and 3. Phase 2 will involve journey mapping exercises with a sub-group of participants with mental-physical multimorbidity to visually map out their care interactions and experiences over time and the critical moments that shaped their experiences. Phase 3 will involve an online, cross-sectional survey of care experiences administered to a larger group of people with mental disorders and/or chronic physical conditions. In phase 4, deliberative dialogues will be held with key partners to discuss and plan strategies for improving the delivery of care to people with mental-physical multimorbidity. Pre-dialogue workshops will enable us to synthesize an prepare the results from the previous three study phases. Discussion Our study results will generate much needed evidence of the positive and negative impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity and shed light on strategies that could improve care quality and experiences.

Wind energy is foundational for achieving 100 % renewable electricity production, and significant innovation is required as the grid expands and accommodates hybrid plant systems, energy-intensive products such as fuels, and a transitioning transportation sector. The sizable investments required for wind power plant development and integration make the financial and operational risks of change very high in all applications but especially offshore. Dependence on a high level of modeling and simulation accuracy to mitigate risk and ensure operational performance is essential. Therefore, the modeling chain from the large-scale inflow down to the material microstructure, and all the steps in between, needs to predict how the wind turbine system will respond and perform to allow innovative solutions to enter commercial application. Critical unknowns in the design, manufacturing, and operability of future turbine and plant systems are articulated, and recommendations for research action are laid out. This article focuses on the many unknowns that affect the ability to push the frontiers in the design of turbine and plant systems. Modern turbine rotors operate through the entire atmospheric boundary layer, outside the bounds of historic design assumptions, which requires reassessing design processes and approaches. Traditional aerodynamics and aeroelastic modeling approaches are pressing against the limits of applicability for the size and flexibility of future architectures and flow physics fundamentals. Offshore wind turbines have additional motion and hydrodynamic load drivers that are formidable modeling challenges. Uncertainty in turbine wakes complicates structural loading and energy production estimates, both around a single plant and for downstream plants, which requires innovation in plant operations and flow control to achieve full energy capture and load alleviation potential. Opportunities in co-design can bring controls upstream into design optimization if captured in design-level models of the physical phenomena. It is a research challenge to integrate improved materials into the manufacture of ever-larger components while maintaining quality and reducing cost. High-performance computing used in high-fidelity, physics-resolving simulations offer opportunities to improve design tools through artificial intelligence and machine learning, but even the high-fidelity tools are yet to be fully validated. Finally, key actions needed to continue the progress of wind energy technology toward even lower cost and greater functionality are recommended.

Arctic permafrost is degrading and is thus releasing nutrients, solutes, sediment and water into soils and freshwater ecosystems. The impacts of this degradation depends on the geochemical characteristics and in large part on the spatial distribution of ground ice and solutes, which is not well-known in the High Arctic polar desert ecosystems. This research links ground ice and solute concentrations, to establish a framework for identifying locations vulnerable to permafrost degradation. It builds on landscape classifications and cryostratigraphic interpretations of permafrost history. Well-vegetated wetland sites with syngenetic permafrost aggradation show a different geochemical signature from polar desert and epigenetic sites. In wetlands, where ground ice contents were high (

Objective We aim to explore the literature that studies the links between life-course socioeconomic status and weight status and characterize the life-course approach used.Introduction Obesogenic environments are increasing rapidly in deprived environments, and cross-sectional studies have shown limitations in explaining the links between these environments and obesity. The life-course approach has been proposed recently to better understand the links between socioeconomic status and weight status.Inclusion criteria Studies that identify life-course socioeconomic status and longitudinal built environment indicators and associate them with body weight indicators between January 2000 and January 2023.Methods Studies in French or English were searched in Medline (PubMed), Web of Science and GeoBase (Embase) according to the strategies formulated for each database. The selected studies were exported to Covidence for evaluation according to the inclusion/exclusion criteria.Results The main results retained are the association between longitudinal socioeconomic indicators and weight measures; longitudinal built environment indicators and the measures of weight.

BackgroundArtificial intelligence (AI)–based chatbots could help address some of the challenges patients face in acquiring information essential to their self-health management, including unreliable sources and overburdened health care professionals. Research to ensure the proper design, implementation, and uptake of chatbots is imperative. Inclusive digital health research and responsible AI integration into health care require active and sustained patient and stakeholder engagement, yet corresponding activities and guidance are limited for this purpose. ObjectiveIn response, this manuscript presents a master protocol for the development, testing, and implementation of a chatbot family in partnership with stakeholders. This protocol aims to help efficiently translate an initial chatbot intervention (MARVIN) to multiple health domains and populations. MethodsThe MARVIN chatbots study has an adaptive platform trial design consisting of multiple parallel individual chatbot substudies with four common objectives: (1) co-construct a tailored AI chatbot for a specific health care setting, (2) assess its usability with a small sample of participants, (3) measure implementation outcomes (usability, acceptability, appropriateness, adoption, and fidelity) within a large sample, and (4) evaluate the impact of patient and stakeholder partnerships on chatbot development. For objective 1, a needs assessment will be conducted within the setting, involving four 2-hour focus groups with 5 participants each. Then, a co-construction design committee will be formed with patient partners, health care professionals, and researchers who will participate in 6 workshops for chatbot development, testing, and improvement. For objective 2, a total of 30 participants will interact with the prototype for 3 weeks and assess its usability through a survey and 3 focus groups. Positive usability outcomes will lead to the initiation of objective 3, whereby the public will be able to access the chatbot for a 12-month real-world implementation study using web-based questionnaires to measure usability, acceptability, and appropriateness for 150 participants and meta-use data to inform adoption and fidelity. After each objective, for objective 4, focus groups will be conducted with the design committee to better understand their perspectives on the engagement process. ResultsFrom July 2022 to October 2023, this master protocol led to four substudies conducted at the McGill University Health Centre or the Centre hospitalier de l’Université de Montréal (both in Montreal, Quebec, Canada): (1) MARVIN for HIV (large-scale implementation expected in mid-2024), (2) MARVIN-Pharma for community pharmacists providing HIV care (usability study planned for mid-2024), (3) MARVINA for breast cancer, and (4) MARVIN-CHAMP for pediatric infectious conditions (both in preparation, with development to begin in early 2024). ConclusionsThis master protocol offers an approach to chatbot development in partnership with patients and health care professionals that includes a comprehensive assessment of implementation outcomes. It also contributes to best practice recommendations for patient and stakeholder engagement in digital health research. Trial RegistrationClinicalTrials.gov NCT05789901; https://classic.clinicaltrials.gov/ct2/show/NCT05789901 International Registered Report Identifier (IRRID)PRR1-10.2196/54668

To decipher the evolution of the hominoid brain and its functions, it is essential to conduct comparative studies in primates, including our closest living relatives. However, strong ethical concerns preclude in vivo neuroimaging of great apes. We propose a responsible and multidisciplinary alternative approach that links behavior to brain anatomy in non-human primates from diverse ecological backgrounds. The brains of primates observed in the wild or in captivity are extracted and fixed shortly after natural death, and then studied using advanced MRI neuroimaging and histology to reveal macro- and microstructures. By linking detailed neuroanatomy with observed behavior within and across primate species, our approach provides new perspectives on brain evolution. Combined with endocranial brain imprints extracted from computed tomographic scans of the skulls these data provide a framework for decoding evolutionary changes in hominin fossils. This approach is poised to become a key resource for investigating the evolution and functional differentiation of hominoid brains.

Testing for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) using dried blood spot (DBS) specimens has been an integral part of bio-behavioural surveillance in Canada for almost two decades, though less is known regarding the use of DBS in surveillance of other sexually transmitted and blood-borne infections (STBBI). A systematic review was conducted using a peer-reviewed search strategy to assess the current evidence regarding the validity of STBBI testing using DBS specimens. Eligibility criteria included studies reporting use of DBS specimens for STBBI testing with either commercially available or "in-house" tests in populations 15 years of age or older. Studies reporting a measure of validity such as sensitivity, specificity, positive and negative predictive values were eligible for inclusion. Quality of studies and risk of bias were assessed using the QUADAS-2 tool. A total of 7,132 records were identified. Of these, 174 met the criteria for inclusion. Among the studies that reported validity measures, a substantial proportion demonstrated high sensitivity (≥90%) in 62.5% of cases (N = 334/534 sensitivity measurements), and high specificity (≥90%) was observed in 84.9% of instances (N = 383/451 specificity measurements). However, the quality of the studies varied greatly. Our findings support the validity of the use of DBS specimens in STBBI testing where sufficient evidence was available, but validity is highly dependent on thorough method development and validation.

Long-term diabetes often leads to chronic wounds refractory to treatment. Cell-based therapies are actively investigated to enhance cutaneous healing. Various cell types are available to produce biological dressings, such as adipose-derived stem/stromal cells (ASCs), an attractive cell source considering their abundancy, accessibility, and therapeutic secretome. In this study, we produced human ASC-based dressings under a serum-free culture system using the self-assembly approach of tissue engineering. The dressings were applied every 4 days to full-thickness 8-mm splinted skin wounds created on the back of polygenic diabetic NONcNZO10/LtJ mice and streptozotocin-induced diabetic K14-H2B-GFP mice. Global wound closure kinetics evaluated macroscopically showed accelerated wound closure in both murine models, especially for NONcNZO10/LtJ; the treated group reaching 98.7% ± 2.3% global closure compared to 76.4% ± 11.8% for the untreated group on day 20 (p=0.0002). Histological analyses revealed that treated wounds exhibited healed skin of better quality with a well-differentiated epidermis and a more organized, homogeneous, and 1.6-fold thicker granulation tissue. Neovascularization, assessed by CD31 labeling, was 2.5-fold higher for the NONcNZO10/LtJ treated wounds. We thus describe the beneficial impact on wound healing of biologically active ASC-based dressings produced under an entirely serum-free production system facilitating clinical translation.

Abstract Objective: The purpose of this study was to create a typology of longitudinal exposure to food environment based on socio-economic context. Design: Food environment trajectories were modelled using a sequence analysis method, followed by a logistic regression to describe those trajectories. Setting: The study took place in Quebec, Canada, using food environment data from 2009, 2011 and 2018 merged with participants’ demographic and socio-economic characteristics. Participant: At recruitment, 38 627 participants between the ages of 40 and 69 years from six urban areas in Quebec were included in the CARTaGENE cohort study. The cohort was representative of the Quebec urban population within this age range. Results: Our study revealed five trajectories of food access over time: (1) limited access to food stores throughout the study period, (2) limited access improving, (3) good access diminishing, (4) good access throughout the period and (5) low access throughout the period. Logistic regression analysis showed that participants who were unable to work (OR = 1·42, CI = 1·08–1·86), lived in households with five or more persons (OR = 1·69, CI = 1·17–2·42) and those living in low-income households (OR = 1·32, CI = 1·03–1·71) had higher odds of experiencing a disadvantaged food environment trajectory. Additionally, the level of education and age of participants were associated with the odds of experiencing a disadvantaged food environment trajectory. Conclusions: The study demonstrates that people facing socio-economic disadvantage are more likely to experience a disadvantaged food environment trajectory over time.

Background: Consuming ultra-processed foods may increase exposure to phthalates, a group of endocrine disruptors prevalent in food contact materials. Objectives: Investigate associations between ultra-processed food intake and urinary phthalates during pregnancy, and evaluate whether ultra-processed foods mediate socioeconomic disparities in phthalate exposures. Methods: In a socioeconomically diverse sample of 1031 pregnant women from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) Study in the urban South, the Block Food Frequency Questionnaire was administered and urinary phthalate metabolites were measured in the second trimester. Linear regressions modeled associations between phthalates and overall ultra-processed food consumption, individual ultra-processed foods, and exploratory factor analysis dietary patterns. Causal mediation analyses examined whether ultra-processed food intake mediates relationships between socioeconomic disparities and phthalate exposures. Results: Ultra-processed foods constituted 9.8–59.0 % (mean = 38.6 %) of participants’ diets. 10 % higher dietary proportion of ultra-processed foods was associated with 13.1 % (95 %CI: 3.4 %–22.9 %) higher molar sum concentrations of di(2-ethylhexyl) phthalate metabolites (ΣDEHP). 10 % higher consumption of minimally-processed foods was associated with lower ΣDEHP (10.8 %: 3.4 %–22.9 %). Ultra- and minimally-processed food consumption were not associated with non-DEHP metabolites. Standard deviation higher consumptions of hamburger/cheeseburger, French fries, soda, and cake were associated with 10.5 % (4.2 %-17.1 %), 9.2 % (2.6 %-16.2 %), 7.4 % (1.4 %-13.6 %), and 6.0 % (0.0 %-12.4 %), respectively, higher ΣDEHP. Exploratory factor analysis corroborated positive associations of processed food with ΣDEHP, and uncovered a healthy dietary pattern associated with lower urinary ΣDEHP, mono(2-ethyl-5-hydroxyhexyl) (MEHHP), mono(2-ethyl-5-carboxypentyl) (MECPP), mono(2-carboxymethylhexyl) (MCMHP), and mono-isononyl (MINP) phthalates. Significant indirect effects indicated that lower income and education levels were associated with 1.9 % (0.2 %-4.2 %) and 1.4 % (0.1 %-3.3 %) higher ΣDEHP, respectively, mediated via increased ultra-processed food consumption. Conclusions: Consumption of ultra-processed foods may increase exposure to phthalates. Policies to reduce dietary phthalate exposures from food packaging and processing are needed, as socioeconomic barriers can preclude dietary recommendations as a sole means to reduce phthalate exposures.

BackgroundScaling effective primary care innovations to benefit more people is of interest to decision makers. However, we know little about how promising innovations are being scaled “spontaneously,” that is, without deliberate guidance. ObjectiveWe aim to observe, document, and analyze how, in real-life conditions, 1 primary care innovation spontaneously scales up across Quebec, Canada. MethodsWe will conduct a participative study using a descriptive single-case study. It will be guided by the McLean and Gargani principles for scaling and reported according to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Informed by an integrated knowledge translation approach, our steering committee will include patient users throughout the project. Inspired by the Quebec College of Family Physician’s “Dragons’ Den” primary care program, we will identify a promising primary care innovation that is being or will be scaled spontaneously. We will interview the innovation team about their scaling experiences every month for 1 year. We will conduct interviews and focus groups with decision makers, health care providers, and end users in the innovation team and the target site about their experience of both scaling and receiving the scaled innovation and document meetings as nonparticipant observers. Interview transcripts and documentary data will be analyzed to (1) compare the spontaneous scaling plan and implementation with the McLean and Gargani principles for scaling and (2) determine how it was consistent with or diverged from the 4 McLean and Gargani guiding principles: justification, optimal scale, coordination, and dynamic evaluation. ResultsThis study was funded in March 2020 by the Canadian Institutes of Health Research. Recruitment began in November 2023 and data collection began in December 2023. Results are expected to be published in the first quarter of 2024. ConclusionsOur study will advance the science of scaling by providing practical evidence–based material about scaling health and social care innovations in real-world settings using the 4 guiding principles of McLean and Gargani. International Registered Report Identifier (IRRID)PRR1-10.2196/54855

Abstract Scientific consensus is that diverse tree species positively impact forest productivity, especially when species are functionally dissimilar. Under the complementarity hypothesis, differences in species traits reduce competition among neighboring tree species. However, while this relationship has been extensively studied at the community level, there is a lack of understanding regarding how individuals of different species specifically respond to a functionally dissimilar neighborhood. In this study, we used permanent plots from Quebec, Canada, and 19 focal tree species to test whether: (1) tree growth response to neighborhood dissimilarity varies with their identity and competition intensity, and (2) focal tree species’ traits explain their response to neighborhood dissimilarity. We demonstrate that: tree growth is primarily influenced by competition, species identity, and their interactions, but that dissimilarity, alone and in interaction with the main drivers of tree growth, explains an additional 1.8% of the variation in species growth. Within this context, (1) most species’ respond positively to neighborhood dissimilarity, with magnitude being species and competition dependent, and (2) focal tree traits partly explain these dependencies, with shade‐intolerant species benefiting most from dissimilar neighbors under high competition. Our study provides empirical support for the complementarity hypothesis, emphasizing the small but consistent positive effect of functional dissimilarity on tree growth in local neighborhoods. Our findings identify the species with the highest potential of benefiting from dissimilar neighbors but also demonstrate that the positive effect of neighborhood dissimilarity is not limited to a select few species with specific traits; rather, it is observed across a diverse range of species. The cumulative growth responses of individuals to functionally dissimilar neighbors may help explain the commonly observed higher productivity in more diverse communities.

IntroductionFollowing a traumatic spinal cord injury (SCI) it is critical to document the level and severity of injury. Neurological recovery occurs dynamically after injury and a baseline neurological exam offers a snapshot of the patient's impairment at that time. Understanding when this exam occurs in the recovery process is crucial for discussing prognosis and acute clinical trial enrollment. The objectives of this study were to: (1) describe the trajectory of motor recovery in persons with acute cervical SCI in the first 14 days post-injury; and (2) evaluate if the timing of the baseline neurological assessment in the first 14 days impacts the amount of motor recovery observed.MethodsData were obtained from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) site in Vancouver and additional neurological data was extracted from medical charts. Participants with a cervical injury (C1–T1) who had a minimum of three exams (including a baseline and discharge exam) were included. Data on the upper-extremity motor score (UEMS), total motor score (TMS) and American Spinal Injury Association (ASIA) Impairment Scale (AIS) were included. A linear mixed-effect model with additional variables (AIS, level of injury, UEMS, time, time2, and TMS) was used to explore the pattern and amount of motor recovery over time.ResultsTrajectories of motor recovery in the first 14 days post-injury showed significant improvements in both TMS and UEMS for participants with AIS B, C, and D injuries, but was not different for high (C1–4) vs. low (C5–T1) cervical injuries or AIS A injuries. The timing of the baseline neurological examination significantly impacted the amount of motor recovery in participants with AIS B, C, and D injuries.DiscussionTiming of baseline neurological exams was significantly associated with the amount of motor recovery in cervical AIS B, C, and D injuries. Studies examining changes in neurological recovery should consider stratifying by severity and timing of the baseline exam to reduce bias amongst study cohorts. Future studies should validate these estimates for cervical AIS B, C, and D injuries to see if they can serve as an “adjustment factor” to control for differences in the timing of the baseline neurological exam.

L’inclusion de jeunes enfants comme sujets participants à la recherche est un phénomène nouveau qui gagne en popularité. Toutefois, leur participation comporte plusieurs défis qui nécessitent des adaptations. Une collecte de données de nature quantitative réalisée auprès de cette population a mené à l’identification de deux écueils importants. Le premier concerne le fait que l’enfant participant est généralement placé dans un rôle d’exécutant. Le second prend appui sur le premier et porte sur l’écart entre ce que nous souhaitons obtenir comme résultats, nos approches et nos objectifs de recherche. En conclusion, nous avançons que pour faire de la recherche porteuse de sens auprès de jeunes enfants, nous devons inévitablement transcender la démarche de recherche et oser porter un regard critique et réflexif sur nos pratiques de recherche.

BackgroundIndocyanine green fluoroscopy has been shown to improve anastomotic leak rates in early phase trials.ObjectiveWe hypothesized that the use of fluoroscopy to ensure anastomotic perfusion may decrease anastomotic leak after low anterior resection.DesignWe performed a 1:1 randomized controlled parallel study. Recruitment of 450 to 1000 patients was planned over 2 years.SettingsThis was a multicenter trial.PatientsIncluded patients were those undergoing resection defined as anastomosis within 10 cm of the anal verge.InterventionPatients underwent standard evaluation of tissue perfusion versus standard in conjunction with perfusion evaluation using indocyanine green fluoroscopy.Main outcome measuresPrimary outcome was anastomotic leak, with secondary outcomes of perfusion assessment and the rate of postoperative abscess requiring intervention.ResultsThis study was concluded early because of decreasing accrual rates. A total of 25 centers recruited 347 patients, of whom 178 were randomly assigned to perfusion and 169 to standard. The groups had comparable tumor-specific and patient-specific demographics. Neoadjuvant chemoradiation was performed in 63.5% of perfusion and 65.7% of standard (p > 0.05). Mean level of anastomosis was 5.2 ± 3.1 cm in perfusion compared with 5.2 ± 3.3 cm in standard (p > 0.05). Sufficient visualization of perfusion was reported in 95.4% of patients in the perfusion group. Postoperative abscess requiring surgical management was reported in 5.7% of perfusion and 4.2% of standard (p = 0.75). Anastomotic leak was reported in 9.0% of perfusion compared with 9.6% of standard (p = 0.37). On multivariate regression analysis, there was no difference in anastomotic leak rates between perfusion and standard (OR = 0.845 (95% CI, 0.375-1.905); p = 0.34).LimitationsThe predetermined sample size to adequately reduce the risk of type II error was not achieved.ConclusionsSuccessful visualization of perfusion can be achieved with indocyanine green fluoroscopy. However, no difference in anastomotic leak rates was observed between patients who underwent perfusion assessment versus standard surgical technique. In experienced hands, the addition of routine indocyanine green fluoroscopy to standard practice adds no evident clinical benefit. See Video Abstract at http://links.lww.com/DCR/B560.Valoracin de la irrigacin de lado izquierdo/reseccin anterior baja pilar iii un estudio aleatorizado, controlado, paralelo y multicntrico que evala los resultados de la irrigacin con pinpoint imgenes de fluorescencia cercana al infrarrojo en la reseccin anterior bajaANTECEDENTES:Se ha demostrado que la fluoroscopia con verde de indocianina mejora las tasas de fuga anastomótica en ensayos en fases iniciales.OBJETIVO:Nuestra hipótesis es que la utilización de fluoroscopia para asegurar la irrigación anastomótica puede disminuir la fuga anastomótica luego de una resección anterior baja.DISEÑO:Realizamos un estudio paralelo, controlado, aleatorizado 1:1. Se planificó el reclutamiento de 450-1000 pacientes durante 2 años.AMBITO:Multicéntrico.PACIENTES:Pacientes sometidos a resección definida como una anastomosis dentro de los 10cm del margen anal.INTERVENCIÓN:Pacientes que se sometieron a la evaluación estándar de la irrigación tisular contra la estándar en conjunto con la valoración de la irrigación mediante fluoroscopia con verde indocianina.PRINCIPALES VARIABLES EVALUADAS:El principal resultado fue la fuga anastomótica, y los resultados secundarios fueron la evaluación de la perfusión y la tasa de absceso posoperatorio que requirió intervención.RESULTADOS:Este estudio se cerró anticipadamente debido a la disminución de las tasas de acumulación. Un total de 25 centros reclutaron a 347 pacientes, de los cuales 178 fueron, de manera aleatoria, asignados a perfusión y 169 a estándar. Los grupos tenían datos demográficos específicos del tumor y del paciente similares. Recibieron quimio-radioterapia neoadyuvante el 63,5% de la perfusión y el 65,7% del estándar (p> 0,05). La anastomosis estuvo en un nivel promedio de 5,2 + 3,1 cm en perfusión en comparación con 5,2 + 3,3 cm en estándar (p> 0,05). Se reportó una visualización suficiente de la perfusión en el 95,4% de los pacientes del grupo de perfusión. El absceso posoperatorio que requirió tratamiento quirúrgico fue de 5,7% de los perfusion y en el 4,2% del estándar (p = 0,75). Se informó fuga anastomótica en el 9,0% de la perfusión en comparación con el 9,6% del estándar (p = 0,37). En el análisis de regresión multivariante, no hubo diferencias en las tasas de fuga anastomótica entre la perfusión y el estándar (OR 0,845; IC del 95% (0,375; 1,905); p = 0,34).LIMITACIONES:No se logró el tamaño de muestra predeterminado para reducir satisfactoriamente el riesgo de error tipo II.CONCLUSIÓN:Se puede obtener una visualización adecuada de la perfusión con ICG-F. Sin embargo, no se observaron diferencias en las tasas de fuga anastomótica entre los pacientes que se sometieron a evaluación de la perfusión versus la técnica quirúrgica estándar. En manos expertas, agregar ICG-F a la rutina de la práctica estándar no agrega ningún beneficio clínico evidente. Consulte Video Resumen en http://links.lww.com/DCR/B560. (Traducción-Dr Juan Antonio Villanueva-Herrero).

Abstract Background The islands of North Maluku, Indonesia occupy a central position in the major prehistoric dispersal streams that shaped the peoples of Island Southeast Asia and the Pacific. Within this region a linguistic contact zone exists where speakers of Papuan and Austronesian languages reside in close proximity. Here we use population genetic data to assess the extent to which North Maluku populations experienced admixture of Asian genetic material, and whether linguistic boundaries reflect genetic differentiation today. Results Autosomal and X-linked markers reveal overall Asian admixture of 67% in North Maluku, demonstrating a substantial contribution of genetic material into the region from Asia. We observe no evidence of population structure associated with ethnicity or language affiliation. Conclusions Our data support a model of widespread Asian admixture in North Maluku, likely mediated by the expansion of Austronesian-speaking peoples into the region during the mid Holocene. In North Maluku there is no genetic differentiation in terms of Austronesian- versus Papuan-speakers, suggesting extensive gene flow across linguistic boundaries. In a regional context, our results illuminate a major genetic divide at the Molucca Sea, between the islands of Sulawesi and North Maluku. West of this divide, populations exhibit predominantly Asian ancestry, with very little contribution of Papuan genetic material. East of the Molucca Sea, populations show diminished rates of Asian admixture and substantial persistence of Papuan genetic diversity.

Abstract Background Behavioural sciences have been shown to support the development of more effective interventions aimed at promoting healthy lifestyles. However, the operationalization of this knowledge seems to be sub-optimal in public health. Effective knowledge transfer strategies are thus needed to optimize the use of knowledge from behavioural sciences in this field. To this end, the present study examined public health practitioners’ perceptions and use of theories and frameworks from behavioural sciences to design health promotion interventions. Methods This study adopted an exploratory qualitative design. Semi-structured interviews were conducted among 27 public health practitioners from across Canada to explore current intervention development processes, the extent to which they integrate theory and framework from behavioural sciences, and their perceptions regarding the use of this knowledge to inform intervention design. Practitioners from the public sector or non-profit/private organizations who were involved in the development of interventions aimed at promoting physical activity, healthy eating, or other healthy lifestyle habits (e.g., not smoking) were eligible to participate. Results Public health practitioners generally agreed that behaviour change is an important goal of public health interventions. On the other hand, behavioural science theories and frameworks did not appear to be fully integrated in the design of public health interventions. The main reasons were (1) a perceived lack of fit with current professional roles and tasks; (2) a greater reliance on experiential-produced knowledge rather than academic knowledge (mainly for tailoring interventions to local setting characteristics); (3) the presence of a fragmented knowledge base; (4) the belief that theories and frameworks require too much time and resources to be operationalized; and 4) the belief that using behavioural sciences might undermine partnership building. Conclusions This study provided valuable insights that may inform knowledge transfer strategies that could be optimally designed to support the integration of behavioural sciences theories and frameworks into public health practices.