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BackgroundIn 2017, the San Francisco Cancer Initiative (SF CAN) established the Colorectal Cancer (CRC) Screening Program to provide technical assistance and financial support to improve CRC screening processes, and outcomes in a consortium of community health centers (CHCs) serving low-income communities in San Francisco. The purpose of this study was twofold: to evaluate the perceived influence of the support provided by the CRC Screening Program's Task Force on CRC screening processes and outcomes in these settings and to identify facilitators and barriers to SF CAN-supported CRC screening activities before and after the onset of the COVID-19 pandemic.MethodsSemi-structured key informant interviews were conducted with consortium leaders, medical directors, quality improvement team members, and clinic screening champions. Interviews were audio-recorded, professionally transcribed, and analyzed for themes. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview questions and organize the analysis.ResultsTwenty-two participants were interviewed. The most commonly cited facilitators of improved screening processes included the expertise, funding, screening resources, regular follow-up, and sustained engagement with clinic leaders provided by the task force. The most salient barriers identified were patient characteristics, such as housing instability; staffing challenges, such as being understaffed and experiencing high staff turnover; and clinic-level challenges, such as lack of ability to implement and sustain formalized patient navigation strategies, and changes in clinic priorities due to the COVID-19 pandemic and other competing health care priorities.ConclusionsImplementing CRC screening programs in a consortium of CHCs is inherently challenging. Technical assistance from the Task Force was viewed positively and helped to mitigate challenges both before and during the pandemic. Future research should explore opportunities to increase the robustness of technical assistance offered by groups such as SF CAN to support cancer screening activities in CHCs serving low-income communities.

Collective cell behavior contributes to all stages of cancer progression. Understanding how collective behavior emerges through cell-cell interactions and decision-making will advance our understanding of cancer biology and provide new therapeutic approaches. Here, we summarize an interdisciplinary discussion on multicellular behavior in cancer, draw lessons from other scientific disciplines, and identify future directions.

Community diversity can reduce the prevalence and spread of disease, but certain species may play a disproportionate role in diluting or amplifying pathogens. Flowers act as both sources of nutrition and sites of pathogen transmission, but the effects of specific plant species in shaping bee disease dynamics are not well understood. We evaluated whether plantings of sunflower (Helianthus annuus), whose pollen reduces infection by some pathogens when fed to bees in captivity, lowered pathogen levels and increased reproduction in free-foraging bumblebee colonies (Bombus impatiens). Sunflower abundance reduced the prevalence of a common gut pathogen, Crithidia bombi, and reduced infection intensity, with an order of magnitude lower infection intensity at high sunflower sites compared with sites with little to no sunflower. Sunflower abundance was also positively associated with greater queen production in colonies. Sunflower did not affect prevalence of other detected pathogens. This work demonstrates that a single plant species can drive disease dynamics in foraging B. impatiens, and that sunflower plantings can be used as a tool for mitigating a prevalent pathogen while also increasing reproduction of an agriculturally important bee species.

Accurate documentation of state-level human papillomavirus (HPV) vaccination is required for public health planning and to inform corrective actions. To examine the representativeness of the California Immunization Registry, we compared the National Immunization Survey (NIS)-Teen, commercial HMOs in California, Medi-Cal, and California Immunization Registry data for HPV vaccine series completion. Our objectives were to evaluate the vaccine registries, compare and report their completeness, and make recommendations on how to improve and use these studies. Vaccination values were extrapolated for all adolescents aged 13 to 17 years from 2018 to 2019 from NIS-Teen, adolescents aged 13 years from 2018 to 2019 reported in the California Immunization Registry, and adolescents aged 13 years for 2018 for commercial HMOs and Medi-Cal. HPV series completion among 13-year-olds in 2018 for commercial HMOs was 50 %, Medi-Cal was 45 %, and the California Immunization Registry was 28 %, with NIS-Teen rates for 13 to 17-year-olds at 50 % in 2018 and 54 % in 2019. Both rural and urban geographic regions were found to have low completion rates of the HPV series, with trends ranging from 13 % to 45 %. The California Immunization Registry's lower HPV vaccine series completion among 13-year-olds compared to the other reporting sources is most likely due differences in reporting and data collection. Importantly, this data will serve as a comparator for future, similar studies of various sources of HPV vaccination rates following the passing of Bill-1797, which will mandate immunization reporting starting in January 2023.

In order to assess computational thinking (CT) modules embedded into multiple STEM courses for educators, we created a CT rubric which incorporates key CT components using Bloom's Taxonomy. We implemented the rubric in four different courses in our pre-service STEM education program for elementary and middle school teachers. We analyzed our rubric results in addition to a pre- and post-survey gauging students' CT skills using the same rubric items. Our rubric results show that students scored well after completing our modules with over 90% in proficiency or high proficiency in all areas in our rubric. We also report on improvements in our CT assignments and scores based on the rubric. In addition, students' self-efficacy in each CT item improved significantly from the beginning to end of the semester. Using the newly developed CT rubric allowed us to assess students' CT skills with a single method across a variety of STEM education courses.

During the last decades, the study of how learners and teachers of mathematics use the resource of language has contributed to our understanding of mathematics teaching and learning in a variety of classrooms and cultures. Developmental work with mathematics teachers on the particular resource of mathematics teaching talk is more recent. In order to explore responses related to the importance of this talk, in this paper we consider three sites of practice in mathematics education--research, professional development and teaching--and illustrations of data from or about them, including studies from the literature, and work with secondary school mathematics teachers in Catalonia-Spain and Malawi around the teaching of angles. We argue that tensions permeate these sites of practice when a focus is placed on word use, specifically the practices of naming and explaining, in mathematics teaching talk. We conclude that the importance of mathematics teaching talk is construed through tensions with other resources in language and teaching. Tensions specifically appear in the realisation of mathematics teaching talk as mediational in the work with mathematics teachers on their classroom teaching.

Due to its high complexity and the varied assembly processes, hybrid assembly systems characterized by human–robot collaboration (HRC) are meaningful. Suitable use cases must be identified efficiently to ensure cost-effectiveness and successful deployment in the respective assembly systems. This paper presents a method for evaluating the potential of HRC to derive automation suitability based on existing or to-be-collected time data. This should enable a quick and favorable statement to be made about processes, for efficient application in potential analyses. The method is based on the Methods–Time–Measurement Basic System (MTM-1) procedure, widely used in the industry. This ensures good adaptability in an industrial context. It extends existing models and examines how much assembly activities and processes can be optimized by efficiently allocating between humans and robots. In the process model, the assembly processes are subdivided and analyzed with the help of the specified MTM motion time system. The suitability of the individual activities and sub-processes for automation are evaluated based on criteria derived from existing methods. Two four-field matrices were used to interpret and classify the analysis results. The process is assessed using an example product from electrolyzer production, which is currently mainly assembled by hand. To achieve high statement reliability, further work is required to classify the results comprehensively.

Digital transformation is advancing across industries, enabling products, processes, and business models that change the way we communicate, interact, and live. It radically influences the evolution of existing systems of systems (SoSs), such as mobility systems, production systems, energy systems, or cities, that have grown over a long time. In this article, we discuss what this means for the future of software engineering based on the results of a research project called DynaSoS. We present the data collection methods we applied, including interviews, a literature review, and workshops. As one contribution, we propose a classification scheme for deriving and structuring research challenges and directions. The scheme comprises two dimensions: scope and characteristics. The scope motivates and structures the trend toward an increasingly connected world. The characteristics enhance and adapt established SoS characteristics in order to include novel aspects and to better align them with the structuring of research into different research areas or communities. As a second contribution, we present research challenges using the classification scheme. We have observed that a scheme puts research challenges into context, which is needed for interpreting them. Accordingly, we conclude that our proposals contribute to a common understanding and vision for engineering dynamic SoS.

Abstract Background The population structure and the correlation between antimicrobial resistance (AMR) phenotypes and genotypes in Aeromonas species isolated from patients with gastroenteritis are not well understood. The aims of the study were to: (1) investigate the antimicrobial susceptibility profiles of Aeromonas species isolated from patients with gastroenteritis; (2) explore the relationship between AMR genes and resistance phenotypes; and (3) describe the population structure of these isolates and provide evidence of transmission events among them. Methods This microbiological survey was performed at the Microbiology Laboratory of the Emek Medical Center in Afula, Israel. Cultivation of Aeromonas was attempted from stool samples that tested positive by PCR. Antimicrobial susceptibility testing (AST) was performed using the Sensititre GN3F microdilution panel. Whole genome sequencing (WGS) was done using the Illumina NextSeq500/550 system. Phylogenetic studies involved multi-locus sequence typing (MLST) and core genome (cg) MLST. Resistance mechanisms were identified using the Comprehensive Antibiotic Resistance Database and compared with the AST results. Results The study included 67 patient-unique isolates. The species that were identified included A. caviae (n = 58), A. dhakensis (n = 3), A. media (n = 2), A. veronii (n = 2) and A. hydrophila (n = 2). Isolates were almost uniformly susceptible to amikacin, gentamicin, aztreonam, cefepime, ceftazidime, ciprofloxacin and meropenem. All isolates with the exception of 1–2 isolates were resistant to ampicillin, cefazolin and ampicillin-sulbactam which was compatible with the presence of the bla OXA genes. Variable resistance rates were observed to cefuroxime, cefoxitin, ceftriaxone, piperacillin-tazobactam that were not correlated with the presence of other β-lactamase genes. Resistance to tetracycline and trimethoprim-sulfamethoxazole correlated with the presence of tetA and sul1, respectively. The population structure of A. caviae was highly diverse with the minority of the isolates (16/57) clustering into six defined sequence types. A cgMLST-based distance of four genes was found in one pair of isolates, suggesting common source transmission. Conclusions A. caviae is the dominant species related to gastroenteritis and is characterized by a diverse population structure, with almost no evidence for common-source transmission. Resistance rates to most antimicrobial agents were low and partially matched with the presence of resistance genes.

Abstract Bacteria are becoming increasingly resistant to antibiotics, reducing our ability to treat infections and threatening to undermine modern health care. Optimising antibiotic use is a key element in tackling the problem. Traditional economic evaluation methods do not capture many of the benefits from improved antibiotic use and the potential impact on resistance. Not capturing these benefits is a major obstacle to optimising antibiotic use, as it fails to incentivise the development and use of interventions to optimise the use of antibiotics and preserve their effectiveness (stewardship interventions). Estimates of the benefits of improving antibiotic use involve considerable uncertainty as they depend on the evolution of resistance and associated health outcomes and costs. Here we discuss how economic evaluation methods might be adapted, in the face of such uncertainties. We propose a threshold-based approach that estimates the minimum resistance-related costs that would need to be averted by an intervention to make it cost-effective. If it is probable that without the intervention costs will exceed the threshold then the intervention should be deemed cost-effective.

Background: Sustainability has proven to be one of the most concerning issues in modern business. Many organizations strive to gain a competitive advantage by employing more sustainable business models and strategies. This empirical research paper aims to explore the dynamics of sustainable business models in Indonesian emerging markets. Purpose: The research analyzes the key factors affecting sustainable business models in Indonesian emerging markets. In addition, this paper evaluates the impact of sustainable business practices on business performance and whether they have been implemented. Consequently, the research also highlights and give major insights into developing innovative business models to empower sustainability in these markets. Methodology: The methodology used in this study is a mixed-method approach. Through this, the researcher can use qualitative data sources. The primary data sources include statistical data, surveys, and interviews with key stakeholders in Indonesian emerging markets. Secondary data sources such as academic literature and industry publications are also significant in getting further information for this research. The study probes into the changing aspects of legitimate business models within the conditions of Indonesian arising markets. Precisely, it enlightens on the complex facts of sustainability operations embraced by corporations managing within these markets. Essential subjects of scrutiny comprise the businesses themselves, partners actively engaged in developing sustainability and valued industry specialists. To ensure an extensive analysis, the methodology used outlines certain tasks necessary for achieving its aims. These tasks entail a meticulous evaluation of the existing written work, accurate data collection attempts, rigorous techniques of data analysis and introspective analysis of the findings. Practically, the study engages a powerful framework consisting of carefully crafted designs of research. These methodologies are fitted to the distinctive background of the Indonesian emerging markets. Findings: The research has numerous findings surrounding the various factors influencing sustainable business models in emerging Indonesian markets. These variables include economic, various market dynamics, and environmental, social, and technological factors. These factors have resulted in various outcomes in the country. In addition, there are extra factors such as infrastructure and logistics, political and regulatory factors, and financial performance. Notably, the statistical analyses reveal the significance of these variables in shaping sustainable business models in the country. Implications: The findings of this study have both practical and theoretical implications. With many countries and agencies advocating for the use of sustainable business, this is a huge issue. Businesses operating in Indonesian emerging markets can use the insights to develop more sustainable and profitable business models. Nonetheless, from the theoretical perspective, the research contributes to understanding sustainable business models in emerging markets and provides a framework for future research in this field. Originality/Value: This research contributes significant value to society. It offers original insights into sustainable business models in Indonesian emerging markets, where limited empirical studies have been conducted. The comprehensive analysis of various variables and their statistical significance adds value to the existing knowledge on sustainability in emerging markets.

Abstract Ethylenediaminetetraacetic acid (EDTA), a classically used chelating agent of decalcification, maintains good morphological details, but its slow decalcification limits its wider applications. Many procedures have been reported to accelerate EDTA-based decalcification, involving temperature, concentration, sonication, agitation, vacuum, microwave, or combination. However, these procedures, concentrating on purely tissue-outside physical factors to increase the chemical diffusion, do not enable EDTA to exert its full capacity due to tissue intrinsic chemical resistances around the diffusion passage. The resistances, such as tissue inner lipids and electric charges, impede the penetration of EDTA. We hypothesized that delipidation and shielding electric charges would accelerate EDTA-based penetration and the subsequent decalcification. The hypothesis was verified by the observation of speedy penetration of EDTA with additives of detergents and hypertonic saline, testing on tissue-mimicking gels of collagen and adult mouse bones. Using a 26% EDTA mixture with the additives at 45°C, a conventional 7-day decalcification of adult mouse ankle joints could be completed within 24 h while the tissue morphological structure, antigenicity, enzymes, and DNA were well preserved, and mRNA better retained compared to using 15% EDTA at room temperature. The addition of hypertonic saline and detergents to EDTA decalcification is a simple, rapid, and inexpensive method that doesn't disrupt the current histological workflow. This method is equally or even more effective than the currently most used decalcification methods in preserving the morphological details of tissues. It can be highly beneficial for the related community.

Abstract Many studies have used mobile device location data to model SARS-CoV-2 dynamics, yet relationships between mobility behavior and endemic respiratory pathogens are less understood. We studied the effects of population mobility on the transmission of 17 endemic viruses and SARS-CoV-2 in Seattle over a 4-year period, 2018-2022. Before 2020, visits to schools and daycares, within-city mixing, and visitor inflow preceded or coincided with seasonal outbreaks of endemic viruses. Pathogen circulation dropped substantially after the initiation of COVID-19 stay-at-home orders in March 2020. During this period, mobility was a positive, leading indicator of transmission of all endemic viruses and lagging and negatively correlated with SARS-CoV-2 activity. Mobility was briefly predictive of SARS-CoV-2 transmission when restrictions relaxed but associations weakened in subsequent waves. The rebound of endemic viruses was heterogeneously timed but exhibited stronger, longer-lasting relationships with mobility than SARS-CoV-2. Overall, mobility is most predictive of respiratory virus transmission during periods of dramatic behavioral change and at the beginning of epidemic waves.

Abstract Measurements of inclusive charged-particle jet production in pp and p-Pb collisions at center-of-mass energy per nucleon-nucleon collision s NN $$ \sqrt{s_{\textrm{NN}}} $$ = 5.02 TeV and the corresponding nuclear modification factor R pPb ch jet $$ {R}_{\textrm{pPb}}^{\textrm{ch}\ \textrm{jet}} $$ are presented, using data collected with the ALICE detector at the LHC. Jets are reconstructed in the central rapidity region |η jet| < 0.5 from charged particles using the anti-k T algorithm with resolution parameters R = 0.2, 0.3, and 0.4. The p T-differential inclusive production cross section of charged-particle jets, as well as the corresponding cross section ratios, are reported for pp and p-Pb collisions in the transverse momentum range 10 < p T , jet ch $$ {p}_{\textrm{T},\textrm{jet}}^{\textrm{ch}} $$ < 140 GeV/c and 10 < p T , jet ch $$ {p}_{\textrm{T},\textrm{jet}}^{\textrm{ch}} $$ < 160 GeV/c, respectively, together with the nuclear modification factor R pPb ch jet $$ {R}_{\textrm{pPb}}^{\textrm{ch}\ \textrm{jet}} $$ in the range 10 < p T , jet ch $$ {p}_{\textrm{T},\textrm{jet}}^{\textrm{ch}} $$ < 140 GeV/c. The analysis extends the p T range of the previously-reported charged-particle jet measurements by the ALICE Collaboration. The nuclear modification factor is found to be consistent with one and independent of the jet resolution parameter with the improved precision of this study, indicating that the possible influence of cold nuclear matter effects on the production cross section of charged-particle jets in p-Pb collisions at s NN $$ \sqrt{s_{\textrm{NN}}} $$ = 5.02 TeV is smaller than the current precision. The obtained results are in agreement with other minimum bias jet measurements available for RHIC and LHC energies, and are well reproduced by the NLO perturbative QCD Powheg calculations with parton shower provided by Pythia8 as well as by Jetscape simulations.

Abstract Agriculture-based industries generate huge amounts of byproducts/wastes every year, which are not exploited or disposed efficiently posing an environmental problem with implications to human and animal health. Finding strategies to increase the recycling of agro-industrial byproducts/wastes (AIBWs) is a primary objective of the current study. A thorough examination of AIBWs in conjunction with experimental research is proposed to facilitate sorting for various agro-industrial applications and consequently increasing byproduct/waste utilization. Accordingly, two sustainable, locally available sources of AIBWs, namely, wheat bran (WB) and garlic straw and peels (GSP) were studied in detail including content and composition of proteins, phytohormones and nutritional elements, as well as the effect of AIBW extracts on plant and microbial growth. Hundreds of proteins were recovered from AIBW mainly from WBs, including chaperons, metabolite and protein modifying enzymes, and antimicrobial proteins. In-gel assays showed that WB and GSP possess high protease and nuclease activities. Conspicuously, phytohormone analysis of AIBWs revealed the presence of high levels of strigolactones, stimulants of seed germination of root parasitic weeds, as well as indole acetic acid (IAA) and abscisic acid (ABA). Garlic straw extract strongly inhibited germination of the weed Amaranthus palmeri but not of Abutilon theophrasti and all examined AIBWs significantly affected post-germination growth. Bacterial growth was strongly inhibited by garlic straw, but enhanced by WBs, which can be used at least partly as a bacterial growth medium. Thus, an in-depth examination of AIBW characteristics will enable appropriate sorting for diverse agro-industrial applications, which will increase their utilization and consequently their economic value.

The global push for sustainable energy has heightened the demand for green hydrogen, which is crucial for decarbonizing heavy industry. However, current electrolysis plant capacities are insufficient. This research addresses the challenge through optimizing large-scale electrolysis construction via standardization, modularization, process optimization, and automation. This paper introduces H2Giga, a project for mass-producing electrolyzers, and HyPLANT100, investigating large-scale electrolysis plant structure and construction processes. Modularizing electrolyzers enhances production efficiency and scalability. The integration of AutomationML facilitates seamless information exchange. A digital twin concept enables simulations, optimizations, and error identification before assembly. While construction site automation provides advantages, tasks like connection technologies and handling cables, tubes, and hoses require pre-assembly. This study identifies key tasks suitable for automation and estimating required components. The Enapter Multicore electrolyzer serves as a case study, showcasing robotic technology for tube fittings. In conclusion, this research underscores the significance of standardization, modularization, and automation in boosting the electrolysis production capacity for green hydrogen, contributing to ongoing efforts in decarbonizing the industrial sector and advancing the global energy transition.

Abstract Background This paper describes the protocols for a randomized controlled trial using a parallel-group trial design that includes an intervention designed to address social isolation and loneliness among people experiencing homelessness known as Miracle Friends and an intervention that combines Miracles Friends with an economic poverty-reduction intervention known as Miracle Money. Miracle Friends pairs an unhoused person with a volunteer “phone buddy.” Miracle Money provides guaranteed basic income of $750 per month for 1 year to Miracle Friends participants. The study will examine whether either intervention reduces social isolation or homelessness compared to a waitlist control group. Methods Unhoused individuals who expressed interest in the Miracle Friends program were randomized to either receive the intervention or be placed on a waitlist for Miracle Friends. Among those randomized to receive the Miracle Friends intervention, randomization also determined whether they would be offered Miracle Money. The possibility of receiving basic income was only disclosed to study participants if they were randomly selected and participated in the Miracle Friends program. All study participants, regardless of assignment, were surveyed every 3 months for 15 months. Results Of 760 unhoused individuals enrolled in the study, 256 were randomized to receive Miracle Friends, 267 were randomized to receive Miracle Money, and 237 were randomized to the waitlist control group. In the two intervention groups, 360 of 523 unhoused individuals were initially matched to a phone buddy. Of the 191 study participants in the Miracle Money group who had been initially matched to a volunteer phone buddy, 103 were deemed to be participating in the program and began receiving monthly income. Discussion This randomized controlled trial will determine whether innovative interventions involving volunteer phone support and basic income reduce social isolation and improve housing outcomes for people experiencing homelessness. Although we enrolled unhoused individuals who initially expressed interest in the Miracle Friends program, the study team could not reach approximately 30% of individuals referred to the study. This may reflect the general lack of stability in the lives of people who are unhoused or limitations in the appeal of such a program to some portion of the unhoused population. Trial registration ClinicalTrials.gov NCT05408884 (first submitted on May 26, 2022).

Abstract AI tools intend to transform mental healthcare by providing remote estimates of depression risk using behavioral data collected by sensors embedded in smartphones. While these tools accurately predict elevated depression symptoms in small, homogenous populations, recent studies show that these tools are less accurate in larger, more diverse populations. In this work, we show that accuracy is reduced because sensed-behaviors are unreliable predictors of depression across individuals: sensed-behaviors that predict depression risk are inconsistent across demographic and socioeconomic subgroups. We first identified subgroups where a developed AI tool underperformed by measuring algorithmic bias, where subgroups with depression were incorrectly predicted to be at lower risk than healthier subgroups. We then found inconsistencies between sensed-behaviors predictive of depression across these subgroups. Our findings suggest that researchers developing AI tools predicting mental health from sensed-behaviors should think critically about the generalizability of these tools, and consider tailored solutions for targeted populations.

Over heterogeneous, mountainous terrain, the determination of spatial heterogeneity of any type of a turbulent layer has been known to pose substantial challenges in mountain meteorology. In addition to the combined effect in which buoyancy and shear contribute to the turbulence intensity of such layers, it is well known that mountains add an additional degree of complexity via non-local transport mechanisms, compared to flatter topography. It is therefore the aim of this study to determine the vertical depths of both daytime convectively and shear-driven boundary layers within a fairly wide and deep Alpine valley during summertime. Specifically, three Doppler lidars deployed during the CROSSINN (Cross-valley flow in the Inn Valley investigated by dual-Doppler lidar measurements) campaign within a single week in August 2019 are used to this end, as they were deployed along a transect nearly perpendicular to the along-valley axis. To achieve this, a bottom-up exceedance threshold method based on turbulent Doppler spectrum width sampled by the three lidars has been developed and validated against a more traditional bulk Richardson number approach applied to radiosonde profiles obtained above the valley floor. The method was found to adequately capture the depths of convective turbulent boundary layers at a 1 min temporal and 50 m spatial resolution across the valley, with the degree of ambiguity increasing once surface convection decayed and upvalley flows gained in intensity over the course of the afternoon and evening hours. Analysis of four intensive observation period (IOP) events elucidated three regimes of the daytime mountain boundary layer in this section of the Inn Valley. Each of the three regimes has been analysed as a function of surface sensible heat flux H, upper-level valley stability Γ, and upper-level subsidence wL estimated with the coplanar retrieval method. Finally, the positioning of the three Doppler lidars in a cross-valley configuration enabled one of the most highly spatially and temporally resolved observational convective boundary layer depth data sets during daytime and over complex terrain to date.

Abstract Background Stakeholder engagement is essential to the design, implementation and evaluation of complex mental health interventions like peer support. Theory of Change (ToC) is commonly used in global health research to help structure and promote stakeholder engagement throughout the project cycle. Stakeholder insights are especially important in the context of a multi-site trial, in which an intervention may need to be adapted for implementation across very different settings while maintaining fidelity to a core model. This paper describes the development of a ToC for a peer support intervention to be delivered to people with severe mental health conditions in five countries as part of the UPSIDES trial. Methods One hundred thirty-four stakeholders from diverse backgrounds participated in a total of 17 workshops carried out at six UPSIDES implementing sites across high-, middle- and low-income settings (one site each in India, Israel, Uganda and Tanzania; two sites in Germany). The initial ToC maps created by stakeholders at each site were integrated into a cross-site ToC map, which was then revised to incorporate additional insights from the academic literature and updated iteratively through multiple rounds of feedback provided by the implementers. Results The final ToC map divides the implementation of the UPSIDES peer support intervention into three main stages: preparation, implementation, and sustainability. The map also identifies three levels of actors involved in peer support: individuals (service users and peer support workers), organisations (and their staff members), and the public. In the UPSIDES trial, the ToC map proved especially helpful in characterising and distinguishing between (a) common features of peer support, (b) shared approaches to implementation and (c) informing adaptations to peer support or implementation to account for contextual differences. Conclusions UPSIDES is the first project to develop a multi-national ToC for a mental health peer support intervention. Stakeholder engagement in the ToC process helped to improve the cultural and contextual appropriateness of a complex intervention and ensure equivalence across sites for the purposes of a multi-site trial. It may serve as a blueprint for implementing similar interventions with a focus on recovery and social inclusion among people with mental ill-health across diverse settings. Trial registration ISRCTN26008944 (Registration Date: 30/10/2019).

Abstract Background Some of the most common complaints addressed by primary care physicians (PCPs) require manual procedures, such as lacerations repair, abscesses drainage, ingrown toenails removal, dry needling for myofascial pain syndrome, and Epley maneuver for treating benign paroxysmal positional vertigo (BPPV). The aim of this study was to describe the procedural skills workshops program for PCPs implemented in Maccabi Healthcare Services and to investigate how many PCPs have participated and used the skills since the program’s inception in 2017. Methods In this observational study, we followed all participants in courses from 2017 to 2021. We extracted all procedures performed during these years by PCPs who learned the skill in MHS. Results During the study period, 620 PCPs participated in workshops for dry needling, soft-tissue and joint injections, BPPV treatment, minor surgical procedures, and spirometry. Most procedures performed were dry needling (average annual number 3,537) and minor surgical procedures (average annual number 361). The average annual use per physician was highest for dry needling (annual average use per physician who used the learned skill was 50.9), followed by soft tissue and joint injections (16.8), minor surgical procedures (14.8), and BPPV treatment (7.5). Conclusion procedural skills workshops may expand PCPs’ therapeutic arsenal, thus empowering PCPs and providing more comprehensive care for patients. Some manual skills, such as dry needling, soft tissue injections, and the Epley maneuver, were more likely to be used by participants than other skills, such as spirometry and soft tissue injections.

This study is to report the demographics, incidence, and patterns of spinal injuries associated with border crossings resulting from a fall from a significant height. A retrospective cohort study was performed at a Level I trauma center from January 2016 to December 2021 to identify all patients who fell from a significant height while traversing the U.S.-Mexico border and were subsequently admitted. A total of 448 patients were identified. Of the 448 patients, 117 (26.2%) had spine injuries and 39 (33.3%) underwent operative fixation. Females had a significantly higher incidence of spine injuries (60% vs. 40%; p?15 (RR?=?3.2; p?15 sustained falls from a higher distance (median 6.1 vs. 5.5?m) and had a longer length of ICU stay (median 3 vs. 0 days). All patients with operative spine injuries had an ISS >15 relative to 50% of patients with non-operative spine injuries (median ISS 20 vs. 15; p?0.001). Patients with spine trauma requiring surgery had a higher incidence of head (RR?=?3.5; p 0.0353) and chest injuries (RR?=?6.0; p?=?0.0238), but a lower incidence of lower extremity injuries (RR?=?0.5; p?

Abstract Background The use of medical health applications (mHealth apps) by patients, caregivers, and physicians is widespread. mHealth apps are often employed by physicians to quickly access professional knowledge, guide treatment, easily retrieve medical records, and monitor and manage patients. This study sought to characterize the use of mHealth apps among primary care physicians (PCPs) in Israel. The reasons for using apps and barriers to their use were also investigated. Methods From all MHS’ PCPs, we randomly selected 700 PCPs and invited them to complete a questionnaire regarding the use of mHealth apps and attitudes toward them. Results From August 2020 to December 2020, 191 physicians completed the questionnaire (response rate 27.3%). 68.0% of PCPs reported using mHealth apps. Telemedicine service apps were the most frequently used. Medical calculators (used for clinical scoring) and differential diagnosis apps were the least frequently used. The most common reason for mHealth app use was accessibility, followed by time saved and a sense of information reliability. Among infrequent users of apps, the most common barriers reported were unfamiliarity with relevant apps and preference for using a computer. Concerns regarding information reliability were rarely reported by PCPs. Physician gender and seniority were not related to mHealth app use. Physician age was related to the use of mHealth apps. Conclusions mHealth apps are widely used by PCPs in this study, regardless of physician gender or seniority. Information from mHealth apps is considered reliable by PCPs. The main barrier to app use is unfamiliarity with relevant apps and preference for computer use.

Background: Infective endocarditis continues to be a significant concern and may be undergoing an epidemiological transition. Methods: Were studied 1804 consecutive episodes of infective endocarditis between 1978 and 2022. The mean age was 48 ( ± 19), and 1162 (64%) patients were male. Temporal trends in demographic data, comorbidities, predisposing conditions, microorganisms, complications and in-hospital death have been studied over the decades (1978–1988, 1989–1999, 2000–2010 and 2011–2022). The outcomes and clinical characteristics were modeled using nonlinear cubic spline functions. Findings: Valve surgery was performed in 50% of the patients and overall in-hospital mortality was 30%. From the first to the fourth decade studied, the average age of patients increased from 29 to 57 years (p

Purpose: The study examines the efficacy of using recycled abattoir waste fertilizer as a sustainable nutrient input for crop Production. Method: Two pot experiments were set up in a controlled environment room to examine biomass yields of ryegrass (Lolium perenne AberMagic), grain yields of spring wheat (Triticum aestivum KWS Cochise), and their micro and macronutrient uptakes, respectively, in an abattoir waste organomineral fertilizer amended soil compared to those treated with inorganic NPK fertilizer. Phosphorus was added at rates of 0, 25, 50, 100, 200, 300, 400, 500, 600, 800, 1000, and 1200 mg P kg-1 in a low P south-west England soil. Results: Total biomass yields of ryegrass in the NPK treatments were higher at application rates greater than 800 mg P kg-1 soil compared with their corresponding abattoir waste organomineral fertilizer (ThalloTM) treatments. Total wheat dry grain weights increased with P addition rates in both the ThalloTM and NPK amended soils until the application rates exceeded 800 mg P kg-1 when the dry grain weights started to decline. Micronutrient concentrations in grass produced from ThalloTM fertilizer-amended soils were similar to those from their corresponding NPK fertilizer treatments. Conclusion: This study demonstrated that if the ThalloTM is added at rates not exceeding 200 mg P kg-1 soil to 300 mg P kg-1 soil, it can serve as a sustainable and cost-effective alternative P source for ryegrass and wheat grain production. However, its application did not increase the micronutrient density of ryegrass or wheat grain any more than inorganic NPK additions. Highlight ThalloTM, an organomineral fertilizer, enhances ryegrass and spring wheat production. ThalloTM applied at 200-300 mg P kg-1 soil is a cost-effective P source for ryegrass and wheat production. Above 800 mg P kg-1 soil, ThalloTM reduces ryegrass biomass and wheat grain weights. ThalloTM effectively sustains micronutrient levels in ryegrass comparable to NPK fertilizer. Thallo™ is an eco-friendly alternative to conventional NPK fertilizers.

Jeremy Adler,1 Theresa Mallick-Searle,2 Mark Garofoli,3 Amanda Zimmerman4 1Pacific Pain Medicine Consultants, Encinitas, CA, USA; 2Division of Pain Medicine, Stanford Health Care, Redwood City, CA, USA; 3West Virginia University School of Pharmacy, Morgantown, WV, USA; 4West Forsyth Pain Management, Winston-Salem, NC, USACorrespondence: Jeremy Adler, Pacific Pain Medicine Consultants, 477 N. El Camino Real, Ste B301, Encinitas, CA, 92024, USA, Email jadler@pacificpainmed.comAbstract: Due to the prevalence of chronic pain and high-impact chronic pain in the US, a significant percentage of the population is prescribed opioids for pain management. However, opioid use disorder is associated with reduced quality of life, along with fatal opioid overdoses, and is a significant burden on the US economy. Considering the clinical needs of patients with intractable chronic pain and the potential harms associated with prescribed and illicit opioids in our communities, having a deep understanding of current treatment options, supporting evidence, and clinical practice guidelines is essential for optimizing treatment selections. Buprenorphine is a Schedule III opioid with a unique mechanism of action, allowing effective and long-lasting analgesia at microgram doses with fewer negative side effects and adverse events, including respiratory depression, when compared with other immediate-release, long-acting, and extended-release prescription opioids. Due to its relatively lower risk for overdose and misuse, buprenorphine was recently added to the Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain as a first-line treatment for chronic pain managed by opioids by the US Departments of Defense and Veterans Affairs, and the Department of Health and Human Services recommends that buprenorphine be made available for the treatment of chronic pain. In this narrative review, we discuss the different buprenorphine formulations, clinical efficacy, advantages for older adults and other special populations, clinical practice guideline recommendations, and payer considerations of buprenorphine and suggest that buprenorphine products approved for chronic pain should be considered as a first-line treatment for this indication.Keywords: opioid analgesics, partial opioid agonists, opioid crisis, chronic pain

Abstract In 2011, a leading investigative television program in Israel launched a series of short documentaries entitled “Four Minutes,” each dedicated to an Israeli political leader. This paper focuses on three of these documentaries, dedicated to then-president Shimon Peres; then-Knesset member Tzipi Livni, who 2 years earlier had won the elections but failed to form a government, and Rabbi Ovadia Yosef, the founder of the Ultra-Orthodox Sephardi “Shas” party. Our goal is to outline the means by which these films construct and deliver their condensed messages, and to explore how, despite the rigid constraints of the format, they create a cohesive and complex portrait of these political figures and their strategic agendas. We analyze how the films’ multimodal language is used to reflect the messages promoted by each of the figures as well as by the filmmakers themselves.

Abstract Background The prevalence of obesity has been increasing worldwide and is associated with increased risk of morbidity and mortality. Weight management can reduce the risk of complications and improve the quality of life of patients with obesity. This study explored primary care physicians’ (PCPs’) attitudes and knowledge about weight management. Methods An anonymous questionnaire was distributed to 400 PCPs between 2020 and 2021. The survey included questions on treatment approaches (pharmaceutical and surgical) and items regarding the respondents’ demographic characteristics. We compared PCPs with low or high proactivity toward weight management. We explored attitudes and knowledge with the chi-square test for categorical variables or the Mann-Whitney test for continuous variables. Results A total of 145 PCPs answered our survey (a response rate of 36.25%). More than half (53.8%) of the respondents showed low proactivity toward weight management in their practice. Proactive respondents were more likely to believe that pharmaceutical treatment effectively reduces weight and offered medical and surgical treatment options more frequently to their patients. Lack of knowledge was the most predominant reason for PCPs avoiding offering treatment to their patients, especially in less proactive PCPs (33.3% vs. 5.3%, p-value